Pharm exam 3

Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium (Lithobid)? A. Urinalysis B. Serum glucose C. Serum electrolytes D. Complete blood count

Answer: C Rationale: Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.

Methylphenidate (Ritalin) should not be taken by patients with a history of which condition? Renal failure Cataracts Hypothyroidism Coronary artery disease

Answer: D Rationale: Methylphenidate (Ritalin) is contraindicated in patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.

Inhalation Anesthetics

methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane) Usually combined with a barbiturate (e.g., thiopental), a strong analgesic (e.g., morphine), and a muscle relaxant (e.g., pancuronium) Adverse effects: respiratory depression, hypotension, dysrhythmias, and hepatic dysfunction Malignant hyperthermia

Spinal block:

penetration of the anesthetic into the subarachnoid membrane, the second layer of the spinal cord

Caudal block:

placed near the sacrum

Epidural block:

placement of the local anesthetic in the outer covering of the spinal cord, or the dura mater

Agitation Delusions Paranoia Hallucinations Incoherent speech are examples of ________________? What does that mean?

positive symptoms in Schizophrenia,characterized by exaggeration of normal function

A woman comes in and wants a refill on her Fentonyl. What would a nurse need to inquire of before giving an opioid?

pregnancy breastfeeding? Alcohol use? Check pupils for OD

A patient wants to use a more natural drug. the nurse recommends a melatonin agonist. Which drug is likely the one the nurse recommended?

ramelteon (Rozerem)

What does Granulocyte colony-stimulating factor do?

regulates production of WBCs

A patient complains of a "deep throbbing pain and that it aches constantly", the nurse would identify this as what kind of pain?

somatic

A patient has never had meds before for their schizophrenic conditon. They are given Aripiprazole (Abilify), and the family asks why that medication was chosen, what does the nurse say?

symptoms of schizophrenia Positive sx are "in your face" hallucinations, illusions, bizarre behaviors and thoughts Negative sx are "recessive" or "depressive" withdrawal, speech poverty, avolition Less likely to cause EPS or tardive dyskinesia

A patient is presented with persistent nausea, diarrhea, tremors, confusion, an irregular heart rate, and has had a seizure. After gaining access to a med list he has a prescription for Litihum, what would be the next nursing interventions?

test lithium levels, presents signs for toxicicty levels of Lithium

what is pain tolerance?

the amount of pain one can endure without it interfering with normal daily functioning

What would show that modafinil (Provigil) is working?

the amount of time patients with narcolepsy feel awake is increased

What is vital for a patient being given Hydromorphone (Dilaudid)?

they are well hydrated, nurse needs to watch respirations

What pt education would a nurse need to do for administering Vincristine?

watch for signs of nuerotoxicity- numbness, tingling, loss of deep tendon function, visual disturbances seizures and bronchospams- life threatening

Which of the following medications would a nurse suspect a pt suffering from asthma related to COPD and bronchitis be recieving? A) Ephinephrine B)Catecholemines C) Albuterol D)Ambien

C- Treats bronchospasm, asthma, bronchitis, COPD

What are adjunct therapies? Examples

Adjuvant therapy is usually used along with a nonopioid and opioid. Examples of adjuvant analgesics include anticonvulsants, antidepressants, corticosteroids, antidysrhythmics, and local anesthetics.

A patient is showing signs of nausea, diarrhea, fever and jaundice in the eyes and skin. The nurse checks the chart and sees that they have recieved a large amount of tylenol for the past two days. What does the nurse then need to do?

Administer the antidote mucomyst Check liver enzymes

What pt edu needs to be done for a pt on Resiperidole?

Warn patient not to combine drug with alcohol, narcotics, or other CNS depressants. Warn against sudden discontinuation of antipsychotics to avoid sudden recurrence of psychotic symptoms. Urine will be pink to brown red

A patient comes in complaining of a terrible pain in their side. What further questions would a nurse need to ask?

What provoked this? Quality or type of pain? Region and radiation? Severity? Time or duration? REMEMBER PQRST

What interventions does a nurse need to practice when opiods have been administered?

-Monitor vital signs at frequent intervals to detect respiratory changes. Fewer than 10 respirations per minute can indicate respiratory distress. -icon Check for pupil changes and reaction. Pinpoint pupils can indicate morphine overdose. -Have naloxone available as an antidote to reverse respiratory depression if morphine overdose occurs. -vital and I&O

What would be teaching that needs to be completed for a woman taking Lithium?

-Teach patient to wear medical alert identification. -Teach patient to take drug as prescribed and keep medical appointments. -Warn against driving motor vehicles or operating dangerous equipment until drug effect is known. -Advise patient that drug effect may take 1 to 2 weeks. -Encourage patient to avoid caffeine, crash diets, NSAIDs, diuretics. -Advise patient against getting pregnant because of teratogenic effects.

What are 5 things that the nurse knows contribute to cancer?

1) genetics 2) Inflammation such as GERD, sun exposure, or chronic inflammation 3) Ineffective diseases such as Hep C 4) Environmental factors such as asbestos, tobacco, pollution 5) Dietary such as a high amount of fatty foods or charred meats

What does the nurse need to keep in mind before administering analgesics?

1. Oral administration of analgesics 2. Analgesics should be given at regular intervals 3. Analgesics should be prescribed according to pain intensity as evaluated by a scale of intensity of pain 4. Dosing of pain medication should be adapted to the individual 5. Analgesics should be prescribed with a constant concern for detail

What is a theraputic range for acetaminophen? What is toxic?

10-20 mcg/mL; the toxic level is greater than 200 mcg/mL 4 hours after ingestion and is usually associated with hepatotoxicity

A pt is given 10 of phenobarbital. what does the nurse know about this drug?

20 to 40 mcg/mL.

What is the max dose for acetaminophen?

4 g/day

After a patient receives chemo when should the nurse be most concerned about them and why?

7-10 days after treatment (nadir) because that is when they are at highest risk because of reduced bone marrow suppression

Which statement shows need for further teaching? A) I may continue using St. Johns Wort with my Venlafaxine B) Venlafaxine is used to treat my depression and anxiety C) I should call my doctor if develop suicidal thoughts D) I should take a bedtime because it may cause drowsiness

A-concurrent interaction of venlafaxine and St. John's wort may increase the risk of serotonin syndrome and neuroleptic malignant syndrome

A 5 year old boy is constantly in the principles office because "He cannot follow through with a task, is always moving and cannot finish assignments". What would a nurse suspect is the cause

ADHD

Sargramostim

Action: accelerates growth and development of bone marrow and circulating blood cell activity after chemotherapy in bone marrow transplant patients. Considerations: monitor respirations; monitor for supraventricular dysrhythmias; monitor for renal and hepatic dysfunction; should not be given within 24 hours before or 24 hours after chemotherapy. Side effects: fever, malaise, GI distress, liver damage, alopecia, peripheral edema, dyspnea, blood dyscrasias, renal dysfunction

When a Muscarinic receptor is acted on what parts are affected?

Affect smooth muscles and slow heart rate

What adverse effect may happen for Clozapine? What nursing interventions?

Agranulocytosis Check WBC count weekly

A patient cannot sit still, is often pacing up and down the hallways cannot sit long enough to finish a meal. what does the nurse know this as?

Akathisia- Constant motion (pacing, restlessness)

A pt is prescribed Fentonyl and asks why they are not given morphine. What would a nurse say? A) It is better for you since you just had a minor surgery B) It causes less GI disturbance C) It's more concentrated than morphine so not as much is needed D) the physician likes this medication better

All true but A and B may help address the worries of the patient

What is the category for methyldopa?

Alpha-adrenergic agonist (sympathomimetic) that acts within the CNS

What may be given for management of migraines when they are presented?

Analgesics Aspirin (caffeine), acetaminophen NSAIDs: ibuprofen, naproxen (Aleve) Opioid analgesics Meperidine (Demerol) Butorphanol nasal spray (Stadol NS) Ergot alkaloids Dihydroergotamine mesylate (Migranal) Selective serotonin1 receptor agonists Sumatriptan (Imitrex) Zolmitriptan (Zomig)

A nurse sees that pt is ordered epinephrine, what do they suspect may be a cause?

Anaphylaxis, anaphylactic shock Bronchospasms Cardiogenic shock, cardiac arrest

A patient with major depression has been prescribed fluoxetine (Prozac). What appropriate dosing regimen would the nurse expect? A. 20 mg every morning B. 40 mg 3 times per day C. 50 mg at bedtime D. 100 mg 4 times per day

Answer: A Rationale: Fluoxetine (Prozac) is usually initially ordered at 20 mg every morning and may be increased every 2 weeks with a maximum dose of 80 mg/day. The other answers do not fit these guidelines.

What would indicate to the nurse that the child taking methylphenidate requires more teaching? The child is seen drinking a cola product. The child checks his weight twice a week. The child takes the drug 45 minutes before a meal. The child takes the drug before breakfast and lunch.

Answer: A Rationale: The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should be checked twice a week for weight loss. The drug should be taken 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping.

When providing dietary teaching for a patient taking monamine oxidase inhibitors (MAOIs), the nurse should teach the patient to avoid which food? A. Yogurt B. Avocado C. Grapefruit D. Potato chips

Answer: A Rationale: When taking monamine oxidase inhibitors (MAOIs), patients should avoid cheese, red wine, beer, liver, bananas, yogurt, and sausage.

A nurse is administering epinephrine to a patient during a cardiac arrest. The primary desired action of this medication is to stimulate a heart rate. decrease cerebral blood flow. initiate respirations. increase blood flow to the kidneys.

Answer: A Rationale: Epinephrine is a potent inotropic (strengthens myocardial contraction) drug that increases cardiac output, promotes vasoconstriction and systolic blood pressure elevation, increases heart rate, and produces bronchodilation. High doses can result in cardiac dysrhythmias necessitating electrocardiogram (ECG) monitoring. Epinephrine can also cause renal vasoconstriction, thereby decreasing renal perfusion and urinary output.

A patient with major depression has been prescribed fluoxetine (Prozac). What nursing diagnosis would be most appropriate? A. Social isolation B. Impaired physical mobility C. Impaired urinary elimination D. Disturbed sensory perception

Answer: A Rationale: The most appropriate nursing diagnosis for the patient taking fluoxetine is social isolation. Impaired physical mobility, impaired urinary elimination, and disturbed sensory perception are not associated with fluoxetine.

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? Dantrolene (Dantrium) Tetrabenazine (Xenazine) Propranolol (Inderal) Lorazepam (Ativan)

Answer: A Rationale: Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).

An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue? "Take Benadryl pills each evening before bedtime." "Drink warm milk or chamomile tea before bedtime." "Develop an exercise regimen for the evening hours." "Take naps during the day whenever you feel drowsy."

Answer: B Rationale: Before medications are used, various nonpharmacologic methods should be used to promote sleep, including avoiding strenuous exercise before bedtime and avoiding naps during the day. Drinking warm milk or chamomile tea before bedtime has been found to promote sleep.

Before administering a daily dose of phenytoin (Dilantin), it is most important for the nurse to maintain the patient on bed rest check phenytoin levels monitor intake and output monitor renal function tests

Answer: B Rationale: Checking the phenytoin level is most important because of the narrow therapeutic range of 10 to 20 mcg/mL. Maintaining bed rest and monitoring I&O and renal function tests are not necessary.

The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) states "I must stop drinking coffee and colas." "I can stop this drug after 3 weeks if I feel better." "I must stop drinking alcoholic beverages." "I should not become pregnant while taking this drug."

Answer: B Rationale: Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam (Ativan) for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because taking alcohol with Ativan can be fatal. taking alcohol with Ativan may increase sedative effects. all patients using alcohol should be referred for assistance. Ativan and alcohol antagonize one another.

Answer: B Rationale: Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.

A patient on risperidone (Risperdal) may be at increased risk for injury due to increased potential for aspiration due to sedation. increased risk for falls due to orthostatic hypotension. increased risk for infection due to neutropenia. increased risk for suicide due to changes in thought processes.

Answer: B Rationale: Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? A decrease in pulse and respiratory rate Facial grimacing and tongue spasms An increase in hallucinations A decrease in the patient's level of orientation

Answer: B Rationale: Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

What is the highest priority nursing diagnosis for a patient taking phenytoin (Dilantin)? Anxiety Risk for falls Risk for constipation Deficient fluid volume

Answer: B Rationale: The nursing diagnosis "Risk for falls" has the highest priority for a patient taking phenytoin because it may lead to side effects of dizziness, decreased coordination, and ataxia. Anxiety, constipation, and efficient fluid volume are not side effects of phenytoin, but depression and discoloration of urine are.

Which statement about amitriptyline (Elavil) does the nurse identify as being true? A. The drug is administered first thing in the morning. B. The drug should be discontinued slowly. C. The onset of antidepressant effect is 48 hours. D. Hypertension is a frequent side effect of this drug.

Answer: B Rationale: When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline (Elavil).

Before administering an MAO inhibitor, it is most important for the nurse to assess the patient's A. sexual history. B. socioeconomic status. C. dietary intake. D. hydration status.

Answer: C Rationale: Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.

A patient was discharged 3 days ago on phenytoin (Dilantin) therapy for seizure disorder. The patient comes to the emergency department experiencing seizures. What will be of most value to determine the etiology of the returned seizures? A CT scan An EEG Serum dilantin levels Serum electrolytes

Answer: C Rationale: For dilantin therapy to be effective, a therapeutic serum range of 10 to 20 mcg/mL must be maintained. Subtherapeutic serum levels are a frequent cause of seizures for patients on dilantin therapy.

The most serious adverse effect of spinal anesthesia is hypotension headache respiratory distress tachycardia

Answer: C Rationale: Respiratory distress or failure is the most serious adverse effect of spinal anesthesia.

Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? "It might take 6 weeks or more for the drug to take effect." "I will get up slowly from a seated position." "When I start to feel better, I will cut the dose of my medication in half." "I will avoid exposure to direct sunlight."

Answer: C Rationale: The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching? The patient wants to listen to music on the radio The patient has saved her urine to be measured The patient says she has taken 1800 mL of fluid today The patient requests a cup of kava kava tea to help her get to sleep faster

Answer: D Rationale: Kava kava is an herb that may interact with CNS depressants. Listening to music may promote sleep. Renal impairment should be monitored, and an adequate amount of liquid is necessary.

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include bradycardia. hypothermia. muscle weakness. rhabdomyolysis.

Answer: D Rationale: NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

A patient is taking a hypnotic nightly to enhance sleep. The patient experiences vivid dreams and nightmares. This may be associated with hangover tolerance hypersensitivity REM rebound

Answer: D Rationale: REM rebound, which results in vivid dreams and nightmares, frequently occurs after taking a hypnotic for a prolonged period and then abruptly stopping. A hangover is residual drowsiness resulting in impaired reaction time. Tolerance results when there is a need to increase the dosage over time to obtain the desired effect. Hypersensitivity is the development of skin rashes and urticaria

Which advice will the nurse include when teaching the patient about lithium therapy? A.Take the drug on an empty stomach. B.Eliminate all sodium from your diet. C.Stop taking the lithium when you feel better. D.It may take 1 to 2 weeks before you have any benefits from taking the medication.

Answer: D Rationale: The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.

A patient is experiencing status epilepticus. The nurse anticipates administration of which drug? Phenobarbital (Luminal) Phenytoin (Dilantin) Valproic acid (Depakene) Diazepam (Valium)

Answer: D Rationale: Diazepam (Valium) is the drug of choice for status epilepticus administered IV or lorazepam (Ativan), followed by IV administration of phenytoin (Dilantin). For continued seizures, midazolam (Versed) or propofol (Diprivan) is used followed by high-dose barbiturates.

Which nursing intervention would be most appropriate for a patient taking temazepam (Restoril)? Monitor for fever Give drug intravenously only Monitor daily weights Tell patient to ask for help before standing

Answer: D Rationale: For safety, the patient should ask for help in getting up (especially an older adult who may have an unsteady gait) when taking a sedative-hypnotic. Temperature is usually not affected with temazepam; however, respiratory depression may occur. Temazepam is only given orally. Monitoring daily weight is not necessary, but renal impairment should be monitored.

What is a patient's threshold?

level of stimulants needed to cause pain to them.. varies from person to person.

A child has been diagnosed with attention deficit/hyperactivity disorder (ADHD). Which drug does the nurse anticipate the health care provider will prescribe? Zolmitriptan (Zomig) Doxapram HCl (Dopram) Benzphetamine HCl (Didrex) Methylphenidate HCl (Ritalin)

Answer: D Rationale: Methylphenidate is most commonly used to treat ADHD. Zolmitriptan is used to treat migraines; doxapram is used as a respiratory stimulant, and benzphetamine is an anorexiant.

A patient with reactive depression is ordered to receive fluoxetine (Prozac). Which information will the nurse include when teaching this patient? A. The medication takes effect in 1 week. B. The medication increases libido. C. The medication should be taken with grapefruit juice. D. The medication may cause headaches and insomnia.

Answer: D Rationale: Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice

A 26 year old woman says that she has trouble falling asleep and does not wake up rested. She is diagnosed with insomnia, what are some nonphramalogical measures a nurse can have her try first?

Arise at a specific hour in the morning No daytime naps Warm fluids to drink (warm milk) Caffeine & alcohol avoided 6 hr before bedtime Heavy meals and exercise avoided before bedtime Warm bath, reading, listening to music

A patient taking Fluorouracil/5-fluorouracil (5-FU) or an antimetabolic comes in and says that his hands and feet hurt and are peeling, what does the nurse say to this?

Ask pain level, last dose, report to doctor

What nursing actions should a nurse be sure to do before administering Vincristine (plant alkaloid)?

Assess for signs of respiratory distress during and after drug administration.

Nursing process for anesthetics

Assessment Assess baseline VS, drug history Diagnosis Acute pain r/t injury Ineffective breathing pattern r/t CNS depression Planning Pt will participate in preop prep and understand post op care Pt VS will remain stable post op Interventions Monitor patient's level of consciousness Monitor vital signs (respirations, HR, BP) Respiratory status Cardiovascular status Monitor urine output. Administer analgesics cautiously until patient fully recovers. Dosage may need to be decreased Evaluation

What would the nurse administer for an overdose of Bethanechol?

Atropine

Which outcomes would show antidepressants have been successful? A) Present to have less emotional distress related to diet B)Changes in affect, behavior, communication C)Brighter affect, positive mood, improved appetite and sleep patterns D)Less isolation, more prosocial interactions, engagement in therapies, increase in volition E)Decreased verbal negativity (increased positivity), increased speech fluidity F) Improved relations with family and support staff

B.C,D,E

What may be prescribed for prevention of migraines?

Beta-adrenergic blockers: Propranolol (Inderal) Atenolol (Tenormin) Anticonvulsants: Valproic acid (Depakote) Gabapentin (Neurontin) Tricyclic antidepressants: Amitriptyline (Elavil) Imipramine (Tofranil)

What side effects or possible adverse reactions would a nurse need to educate the pt on?

Blurred vision, miosis Hypotension, bradycardia, sweating Increased salivation and gastric acid, nausea, vomiting, diarrhea, abdominal cramps Bronchoconstriction

What side effects would a nurse expect to see in a beta agonist blocker?

Bradycardia, hypotension, dysrhythmias, headaches, dizziness, fainting, fatigue, mental depression, nausea, vomiting, diarrhea, blood dyscrasias, hypoglycemia

What pt education needs to be done for someone on methylphenidate?

Caffeine may increase effects Decreased effects of decongestants, antihypertensives, barbiturates May alter insulin effects

A patient is given neoadjuvant therapy. What does the nurse will happen with regards to treatment?

Chemo will be given first and then surgery may be done to remove it

What drugs stimulate the PNS?

Cholinergic Agonists / Parasympathomimetics

A pt complains of pain behind his eye and has several this week. What would the nurse reconize the is as?

Cluster headache

Aldesleukin

Considerations: do not shake vial but gently swirl; should store in refrigerator for 48 hours if not used immediately; discard any unused portion. Side effects: capillary leak syndrome, infection, hypotension, GI distress, mental status changes, oliguria/anuria, fever, chills, tachycardia, pulmonary congestion, dyspnea, fatigue, weakness, malaise, anemia, thrombocytopenia.

why would a pt be given phenytoin (Dilantin)? What other nursing considerations?

Contraindications Pregnancy (teratogenic) Therapeutic serum level 10 to 20 mcg/mL (narrow therapeutic range) Side effect/adverse reactions Gingival hyperplasia, nystagmus Headache, diplopia, dizziness, slurred speech, decreased coordination, alopecia Thrombocytopenia, Stevens-Johnson syndrome

propranolol

Contraindications: COPD Side effects/adverse reactions: Impotence, decreased libido, reversible alopecia Drug interactions Decreased drug effects with Phenytoin, isoproterenol, NSAIDs, barbiturates, caffeine, theophylline Heart block may occur with Digoxin, calcium channel blockers

A pt is given Sumatriptan (Imitrex) for migraine managment. What pt education would a nurse need to do?

Dizziness, tingling, numbness, warm sensation, drowsiness, seizures Muscle cramps, nausea, vomiting, diarrhea Dysrhythmias, thromboembolus, heart attack, stroke

A pt recieves the tricyclic antidepressant Amitriptyline. What pt education needs to be done?

Do not drink alcohol or use any other depressants, increased sedation and anticholergic effects with phenothiazines, haloperidol

drug interactions for phenytoin (Dilantin)

Drug interactions Increased effects with cimetidine (Tagamet), INH, sulfonamides Decreased effects with folic acid, antacids, calcium, sucralfate, antineoplastics, antipsychotics, primrose, ginkgo Decreased effects of anticoagulants, oral contraceptives, antihistamines, dopamine, theophylline

A pt recently LOCx4 when given epinephrine is now LOC by name only, is hyperventilating and has nausea and diarrhea. What does the nurse know is happening and what is the correct nursing actions?

Drug may have been given too long, allergic reaction, adverse reaction antidote=phentolamine mesylate (Regitine)

After being diagnosed with ADHD the boy's mother asked why this happens.What is the appropriate response?

Dysregulation of transmitters such as Serotonin, norepinephrine, dopamine

What pt education would need to regarding diet and taking their Lithium medication?

Encourage adequate fluid intake (1 to 2 L daily). Take with food to decrease GI irritation.

A pt is prescribed Lorazepam and asks how it will help with their anxiety. What is the nurse's response.

Enhances GABA neurotransmission by binding to specific benzodiazepine receptors. GABA acts in the central nervous system to put the brakes on anxiety by slowing neurotransmission from the fear centers in the amygdala

While working in the E.R. a patient goes into cardiac arrest. What would the nurse anticipate the pt will be given?

Epinephrine

While getting a breif history for a history in anaplaxis the pt tells the nurse that they are on Atenolol, what does the nurse know can not be administered?

Epinephrine interacts with beta blockers and Digoxin

What nursing interventions would take place for Vascular Endothelial Growth Factor Receptor Inhibitors, and Epidermal Growth Factor Receptor Inhibitors?

Examine patient's skin closely. Monitor for evidence of infection. Assess for evidence of thromboembolic events. Monitor for any signs of bowel perforation. Monitor lab values, renal, hepatic, chemistry, CBC. Assess for cardiac events, dysrhythmias, decreased cardiac output, heart rate, and blood pressure. Assess for pulmonary complications. Teach patient to avoid taking NSAIDs due to bleeding risk.

A patient who is on Haldol now has stooped gesture, has a masklike face, feet shuffle, has tremors, pillrolling hand gestures and exhibits slow movements. What would the nurse recognize about these symptoms?

Extrapyramidal Syndrome (EPS) like symtoms, talk to physican about dose ASAP

Nursing interventions for sedative-hynotics

First use non pharmacologic methods Be attentive to safety Avoid alcohol, other CNS depressants Take 15 to 45 minutes before bedtime Report hangover effect Monitor BP, RR Withdraw gradually

A patient comes in for the first administration of chemo. What assessments would the nurse need to do?

Gather OTC, minerals, antacids etc baseline data- VS Ht& Wt cardiopulmonary function I&O Skin assessment- inquire of changes, lesions examination Kidney function Nutritional status Baseline labs- CBC chemistry Uric acid level Obtain diagnostic tests such as EKGs

This medication is ordered IM, what nursing interventions does the nurse need to be sure to implement for Resperidole?

Give IM by Z track into deep muscle using large-gauge needle. Do not massage injection site.

When would an opioid NOT be given?

Head Injuries - MS = Respirations = Co2 = ICP Respiratory Distress Hypotension (can adjust)

What side effects should the nurse discuss with the pat before giving Fluoxetine?

Headache, nervousness, restlessness Insomnia, tremors, seizures GI distress Sexual dysfunction

What Sedatives and Hypnotics for Older Adults would a nurse need to keep in mind?

Identify cause(s) for insomnia Use non pharmacologic methods first Use short to intermediate-acting benzodiazepines such as estazolam (ProSom), temazepam (Restoril), and triazolam (Halcion) Avoid benzodiazepines such as flurazepam, quazepam (Doral), and diazepam (Valium)

Which would show that methylphenidate (Ritalin) is working for an ADHD pt?

Increase a child's attention span and cognitive performance (e.g., memory, reading) Decrease impulsiveness, hyperactivity, and restlessness

What would be the effects of the beta 1 receptor presented in a patient?

Increased heart contraction and rate Inc BP Inc rennin secretion

A patient is given midazolam (Versed) and propofol (Diprivan) what does the nurse expect about the surgery?

Induction and maintenance of anesthesia or conscious sedation for minor surgery or procedures like mechanical ventilation or intubation Patients are sedated and relaxed but responsive to commands

How does Venlafaxine (Effexor) work?

Inhibits reuptake of seratonin and norepinephrine increasing them in nerve fibers

Barbiturates

Interactions: alcohol, opioids, other sedative-hypnotics

What pt education needs to be done for a pt given Lorazepam?

It has interactions that Increases CNS depression with alcohol, other CNS depressants, cimetidine, aviod

A patient is tested for Lithium levels and it comes back to 2.3. what does this mean to the nurse.

It is at a toxic level (above 1.5- 2.0) Therapeutic serum range: 0.5 to 1.5 mEq/L

A nurse notes that a pt is prescribed Risperidone what do they suspect is the cause for this?

Manage symptoms of psychosis, schizophrenia

A pregnant woman is to undergo a simple procedure, what drug may she be given for pain?

Meperidine (Demerol)

What may a patient be given to help lessen dependence on an opioid?

Methadone

A patient that has recently had a history of continuous seizures. what would the nurse suspect would be prescribed?

Midazolam (Versed) or propofol (Diprivan)

Nursing interventions for Bethanechol?

Monitor BP and HR Teach patient to rise slowly Record fluid intake and output Monitor breath sounds Give 1 hour ac or 2 hours pc Monitor bowel sounds Monitor overdosing

What does a nurse need to monitor for a pt that has been given Epinephrine?

Monitor BP, heart rate, urine output IV site for infiltration

What would a nurse need to for a patient with Tyrosine Kinase and Multikinase Inhibitors?

Monitor IV site frequently for irritation and phlebitis. Encourage small, frequent meals that are high in calories and protein. Assess the need for IV hydration.

What does the nurse need to monitor after dose of Resiperidole?

Monitor for EPS, NMS, WBCs.

After giving Narcan what does the nurse need to watch for?

Monitor vital signs and bleeding continuously.

What nursing interventions does a nurse need to accomplish when giving anxiolytics?

Monitor vital signs. Encourage patient to rise slowly to avoid dizziness. Warn patient that therapeutic response may take 1 to 2 weeks. Advise patient not to drive a motor vehicle or operate dangerous equipment. Patient should not use for more than 3 to 4 months as tolerance develops and effectiveness decreases.

What education for a pt on Aldesleukin?

Nursing interventions Assess for any cardiac events. Monitor appropriate labs. Monitor renal and hepatic function. Monitor patient for any adverse effects. Report symptoms of bleeding immediately. Advise patients and caregivers to immediately report seizures, persistent headache, reduced eyesight, increased blood pressure, or blurred vision.

What nursing interventions would a nurse need to implete for a patient who needs monitored after given antidepressant MAIO?

Monitor vital signs. Monitor mood for drug effectiveness. Monitor for suicidal tendencies, seizures. Warn that foods that contain tyramine can cause a hypertensive crisis with MAOIs. Encourage taking drug as prescribed. Encourage avoiding alcohol, CNS depressants, and cold medicines. Teach to take drug with food if GI distress occurs. Warn patient against driving or using dangerous mechanical equipment until drug effect is known. Warn patient against abruptly stopping drug. Instruct patient to take drug at bedtime. Advise patient that a therapeutic response usually occurs in 2 to 4 weeks. Inform patient that herbs (e.g., St. John's wort, ginseng) may interact with antidepressants.

A nurse sees Tranylcypromine sulfate (Parnate) on a pt's chart and knows that this is a

Monoamine Oxidase Inhibitor- antidepressant

Another sign of psuedoparakasonisms is Acute dystonia, what are signs of this?

Muscle spasms of face, tongue, neck, and back Facial grimacing Involuntary upward eye movements Laryngeal spasms

A patient recently diagnosed with Schizophrenia has been refusing to wash his hair, or brush his teeth, he only talks when he is angry, and does not socialize with anyone else. The nurse what recognize what about these symptoms?

Negative symptoms: characterized by decrease or loss of function and motivation Negative symptoms tend to be more chronic and persistent

A patient was LOCx4 and is now at LOCx1, has a fever, BP is fluctuating, high HR, is siezing and is showing signs of respiratory failure ( low resp, and depth). What does the nurse identify this as?

Neuroleptic Malignant Syndrome

What does a nurse realize a patient on interferons is suspectable to?

Neuropsychiatric disorders Autoimmune disorders Ischemic disorders Infectious disorders fatigue, flu-like

A patient complains of having some arthritis pain, what would be the first step for medications?

Nonopioid Analgesics- or NSAIDS Aspirin Acetaminophen Ibuprofen Naproxen

Pt education for dilaton. anti seziure med

Nursing interventions Shake suspension well for 5 minutes. Monitor serum drug levels. Safety: Protect from environmental hazards, driving. Warn female patients taking oral contraceptives to use additional contraception. Warn patient to avoid certain herbs, alcohol, and other CNS depressants. Warn patient not to discontinue abruptly. Patient will need frequent oral hygiene and dental check-ups. Diabetics must monitor glucose level. Tell each patient to take drug at same time every day. Warn of harmless pinkish red or brown urine. Teach patient to report sore throat, bruising, nosebleeds. Encourage patient to wear medical-alert identification.

A patient is showing signs of respiratory distress, hypotension after last med of hydromorphone. What does the nurse know needs to be done?

Opioid antagonists Naloxone (Narcan) Naltrexone hydrochloride (ReVia) Nalmefene (Revex)

A pt has been prescribed Bethanechol for the past week and now has salivation, sweating, flushing, abdominal cramps. What would this indicate to the nurse?

Overdose of Bethanechol, cholinergic crisis

What would a nurse be concerned about when a patient reports shortness of breath and has edema when on Cyclophosphamide?

Pulmonary toxicity, nephrotoxicity

What patient education would need to be done for those with a suppressed bone marrow?

Report a temp of higher than 101 degrees (38 C) avoid people who have been sick or got a live vaccination avoid raw food or fresh flowers plan rest periods for activities use electric razor and soft toothbrushes

What pt education would a nurse need to do for a pt that has been given Epinephrine?

Report tachycardia, palpitations, tremors, dizziness, hypertension Avoid cold medicines and diet pills if hypertensive, diabetic, CAD, or dysrhythmic Avoid adrenergics when breastfeeding Avoid continuous use of adrenergic nasal sprays

A pregnant patient with hypertension and an cardiac dysarrhythmia has been order Epinephrine, what would be the appropriate nursing action?

Report to provider!! cannot give with Cardiac dysrhythmias, hypertension,Hyperthyroidism, or Pregnancy

A patient is often seen with a look of disgust or angish but this is known as a sign of EPS. What is this?

Tardive dyskinesia (TD) Involuntary Protrusion and rolling of tongue, chewing action Mouth movements

Too much dopamine= Too little=

Schizophrenia Parkinsonism

What side effects does a nurse need to educate a pt about on opiods?

Sedation Respiratory Depression Nausea and Vomiting Constipation Pruritis (tickling, feather like sensation) Xerostomia (Dry Mouth) Urinary Retention

What would the nurse suspect clonidine treat?

Selective alpha2-adrenergic agonist (sympathomimetic) ussed primarily to treat hypertension

A married 25-year-old woman is scheduled to began chemo soon. What would a nurse want to be sure to educate about?

Sexual disfunction possible fertility treatment using a birth control method because of tetrogenesis effects

A pt on Risperidone complains that they get headaches and that the light hurts them, the also said they get dizzy when they stand up, and their heart is racing. The nurse additionally notes that they are constantly drinking, they are slow, gait is shuffled. What does the nurse know these as?

Side effects possible adverse with EPS sx and seizures

What would a nurse be aware of when giving a spinal anasthetic?

Side effects/adverse reactions: respiratory distress, headache, hypotension

What interactions would a nurse want to inform the pt about when taking erthropotien?

Side effects: hypertension, headache, GI distress, fatigue, thrombosis.

What are the stages of anesthesia?

Stage 1: Analgesia Stage 2: Excitement or delirium Stage 3: Surgical Stage 4: Medullary paralysis

What does a nurse do for the patient with Rhabdomyolysis?

Stop antipschotics hydrate, keep warm, benzodiazepines, muscle relacorts, antpyretics

A patient has been given adjunct therapy for a mass in their stomach. What does the nurse suspect will be the first thing done?

Surgery and then chemo

Adrenergic Agonists=

Sympathomimetics

What should a nurse educate a patient about for taking Fluorouracil/5-fluorouracil (5-FU)?

Teach to examine mouth, rinse mouth with NS frequently, avoid commercial mouthwash containing alcohol.

A pt that has been given Lithium has had an HA, drowsiness, slurred speech, increased thirst and urination, and overall muscle weakness. That nurse on duty would reconize what?

That these are normal SE and adverse reactions

A patient has been prescribed Cyclophosphamide (Alklating agent), what would the nurse need to ensure before administration?

That they are well hydrated to prevent hemorrhagic cystitis ( lower UI symptoms)

What should a nurse educate regarding drug, a pt about when given MAOIs?

Vasoconstrictors and cold medications containing phenylephrine and pseudoephedrine can cause a hypertensive crisis when taken with an MAOI.

A patient has a tumor that has been determined to be malignant. The patient asks the nurse what this means. What would the nurse appropriately say?

This means that it has the ability to spread to other cells and other parts of the body. So treatment will need to be done to prevent that

When would a nurse need to be extra cautious when giving Fentonyl?

To a small pt under 110 lbs

What are normal side effects that a nurse would educate a pt about while taking Albuterol?

Tremors, nervousness, restlessness Dizziness, reflex tachycardia

A patient in her 30s comes in with migraines. What could the nurse tell her in terms of nonpharmacolic methods?

Triggers: cheese, chocolate, red wine from imbalance of seratonin

A patient in the outpatient oncology clinic complains of fatigue after receiving chemotherapy. Which initial nursing intervention will be most appropriate? a. Assess for other factors contributing to her fatigue, such as trouble sleeping. b. Encourage a high-protein, high-calorie diet, and design it with the patient. c. Refer the patient to a physical therapist to develop a strenuous exercise program. d. Encourage the patient to sleep as much as possible during the day to ease fatigue.

a

A patient is scheduled to receive chemotherapy drugs that will cause myelosuppression. Which action by the nurse will be most important? a. Monitor for a change in temperature. b. Evaluate gastrointestinal function. c. Assess for evidence of cardiac compromise. d. Question the patient about changes in sense of taste.

a

Which conditions does the nurse know to interfere with Albuterol? A)Pregnancy B)Diabetes Mellitus C)Anxiety D)hypertension E) Severe cardiac disease F) asthma

a,b,d,e

What are some objectives that a nurse could make for someone with Bipolar disorder? A)Increased mood stability (fewer mood swings) B) Increased thoughts of happiness C) Decreased hyperactive behavior D)Less apparent distress E)Slower speech pattern F)Decrease in hypersexual behaviors G)Improved sleep patterns H)Improved appetite

a,c,d,f,g,h

Saddle block:

administered at the lower end of the spinal column to block the perineal area

What side effects would cause the the nurse to take immediate action? A) flushing B) tachycardia C)Cardiac dysrhythmias D) hypotension E) Nausea/ vomiting related to renal function D) cardiac dysrrhtmias

all but b

When would Bethanechol (cholinergic agonist) NOT be administered? A) low BP,pulse B) hypertension C)COPD D)Parkinsonism E)Peptic ulcer F) bronchodilation G)hyperthyroidism

all but b and f

Which of the following are side effects to using Amitriptyline? A) weight gain B) blurred vision C) Cholenergic effects D) hypertension E)Orthostatic hypotension

all but d

What foods should a nurse tell a pt to avoid while taking a MAOI? A)Cheese B) yougurt C) Coffee D) med meats E)yeast F) bananas G)Red wine, beer H) chicken

all but d and h. consumation of tyramine can cause a hypertensive crisis

Select when a local anesthetic may be used a)dental procedures b)blocking nerve impulses (nerve block) below the insertion of a spinal anesthetic c)suturing skin lacerations d)diagnostic procedures such as lumbar puncture and thoracentesis e) brain surgery

all but e

Select all of the contradictions for Risperidone: A) tachycardia B) Dysrhytmias C)hypotension D)WBC (White Blood Cell) count of over 1,000,000 E) damaged liver F)diabetes mellutis

b,d,e

A patient gives a list of current meds to the nurse including Lisniopril, and carbamazepine. The patient is to start Risperidone, what is the approriate nursing action A) give normal dose b) report to provider c) give a reduced dose d) give all meds at once

b- Risp. has Increased effects of antihypertensives and Decreased risperidone levels with concurrent use of carbamazepine

What is the main goal of Nonphenothiazines and phenothiazines?

block dopamine receptors

A pt asks how their Fluoxetine (Prozac) works, what would the nurse say?

blocks uptake of neurotransmitter Serotonin

What does a nurse need to monitor for a patient on Olanzapine?

blood sugar level cholesterol level weight (Hyperglycemia, hyperlipidemia, weight gain common SE)

A pain says that they take tylenol but the pain is still persistant,what type of pain would this be identified as?

breakthrough pain

The nurse is caring for a patient with colorectal cancer who is to receive fluorouracil. Which symptom will be most important for the nurse to report to the health care provider? a. Nausea b. Decreased appetite c. Bleeding gums d. Constipation

c

What are some common analeptics?

caffeine (increase resp) theophylline (increase resp, relaxes bronchioles)

A patient taking Doxorubicin says that their chest is hurting, and their heart is racing and palpatating. What does the nurse know is happening? A) a normal symtoms B)a contraindication with another medication c) a possible heart attack d) an adverse reaction of cardiotoxicity

d- EKG, vitals signs STAT

How would a nurse anticpate how an alpha 2 agonist would act?

decreased BP decreased GI motility and tone

What would be the effects of the beta 2 receptor presented in a patient?

decreased GI tone and motility bronchodilation relaxation of uterine tone increased blood sugar

What contradictions are involved for indirect choliergic agonists?

intestinal obstruction urinary obstruction

What would a nurse need to consider before giving Filgrastim (gran col-stim)?

last dose- not give before 24 b/a chemo

A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect? Nausea Tachycardia Rales Hypotension

Answer: B Rationale: It is most important to monitor the heart rate for tachycardia after atropine is given. Atropine may be given without regard to meals. Rales would not be expected because atropine dries secretions rather than increases them. Hypertension is a more likely response than orthostatic hypotension.

A patient is prescribed scopolamine (Transderm Scōp). It is most important for the nurse to assess the patient for a history of which condition? Diabetes mellitus Glaucoma Allergy to penicillin Gastric ulcer

Answer: B Rationale: Because anticholinergic drugs can increase intraocular pressure, they should not be administered to patients diagnosed with glaucoma.

When teaching a patient who has been prescribed metoprolol (Lopressor) about side/adverse effects, which is the highest priority teaching point? Report any complaints of stuffy nose. Instruct the patient how to take a pulse. Check for bladder distention. Warn of possible impotence and decreased libido

Answer: B Rationale: It is most important for the patient to learn how to monitor the heart rate because of the side effect of bradycardia with metoprolol.

A patient has been prescribed atenolol (Tenormin). To ensure safe dosing, the nurse teaches the patient to frequently assess what parameter? A. Daily weight B. Heart rate C. Urine output D. Body temperature

Answer: B Rationale: The side effects commonly associated with atenolol (Tenormin), which is a beta blocker, include bradycardia, hypotension, headache, dizziness, cold extremities, hypoglycemia, and bronchospasm

A patient is receiving dopamine (Intropin) intravenously. Which drug should the nurse have available to treat extravasation and tissue necrosis? A. Norepinephrine bitartrate (Levophed) B. Nadolol (Corgard) C. Phentolamine mesylate (Regitine) D. Clonidine (Catapres)

Answer: C Rationale: The antidote for IV extravasation of dopamine is phentolamine mesylate (Regitine) 5 to 10 mg, diluted in 10 to 15 mL of saline infiltrated into the area. Norepinephrine bitartrate (Levophed) is an adrenergic agonist; nadolol (Corgard) is a beta1 and beta2 adrenergic blocker, and clonidine (Catapres) is a selective alpha2-adrenergic agonist (sympathomimetic) used primarily to treat hypertension.

The nurse is teaching the patient about the side effects of atenolol (Tenormin). These include pupillary constriction. blood vessel dilation. bronchospasm. tachycardia.

Answer: C Rationale: The side effects commonly associated with beta blockers are bradycardia, hypotension, headache, dizziness, cold extremities, hypoglycemia, and bronchospasm.

A patient received atropine as a preoperative medication 30 minutes ago. The nurse evaluates the medication as effective if the patient states, "I feel like I need to throw up." "I need to urinate." "My mouth feels dry." "I have a headache."

Answer: C Rationale: Atropine is useful primarily (1) as a preoperative medication to decrease salivary secretions and (2) as an agent to increase heart rate when bradycardia is present.

A patient has received atropine. It is most important for the nurse to assess the patient for which effect? A. Anxiety B. Constipation C. Urinary retention D. Impaired oral mucous membrane

Answer: C Rationale: Urinary retention is the highest priority because it is more serious to systemic homeostasis than anxiety, constipation, or a dry mouth.

Atropine is most useful in the treatment of which cardiovascular condition? Ventricular fibrillation First-degree heart block Premature atrial contraction Sinus bradycardia

Answer: D Rationale: Atropine is used to treat sinus bradycardia.

describe the nursing process for adrenergic blockers?

Assessment Assess vitals, EKG Assess drug & medical history Diagnosis Decreased CO r/t hypotension and bradycardia Risk for falls r/t dizziness Fatigue r/t medical adverse effects Sexual dysfunction r/t adverse effect of erective and ejaculatory dysfunction Noncompliance r/t undesired adverse effects Planning Pt will adhere to drug regimen Pt vitals will be within desired range Interventions Monitor vitals, complaints of dizziness, etc. Assist w/ ambulation Note any c/o of stuffy nose r/t vasodilation Evaluation Evaluate effectiveness of adrenergic blocker VS within desired range

Nursing Process: Benzodiazepines

Assessment Obtain drug history and herbals Assess baseline VS Assess history of insomnia or anxiety disorders Assess renal function, urine output > 1500ml/day Diagnosis Sleep deprivation r/t adverse effect of insomnia Risk for injury r/t dizziness and hypotension Ineffective breathing pattern r/t CNS depression Ineffective sexuality pattern r/t adverse effect of erectile dysfunction Planning Pt will receive adequate sleep when taking benzodiazepines Interventions Use bed alarms for older adults/confusion Observe for adverse reactions Examine skin for rashes Patient Teaching Teach pt to use non-pharmacologic ways to induce sleep (take warm bath, listen to music, drink warm fluid) Avoid alcohol and antidepressant, antipsychotic, and opioid drugs while taking benzodiazepines. Respiratory depression may occur when combined Do not drive or operate a motor vehicle Herbal Warning Kava Kava should not be taken with CNS depressants such as barbiturates and opioids (increases sedative effects) Valerian when taken with alcohol and other CNS depressants such as barbiturates may increase the sedatives effects of the drug.

Come up with nursing process for anticolingerics such as Atropine

Assessment: Assess VS, watch for tachycardia Assess UO, watch for urinary retention Assess drug & medical history Diagnosis: Impaired urinary elimination r/t urinary retention Impaired oral mucous membranes r/t decreased oral secretions Risk for injury r/t acute confusion Risk for constipation r/t decreased peristalsis Planning: Pt secretions will be decreased Nursing interventions: Monitor vital signs, urine output, bowel sounds Monitor safety: bedside rails, driving motor vehicles Provide mouth care and eye drops. Avoid hot environments Avoid alcohol, cigarettes, caffeine, and aspirin at bedtime Wear sunglasses in bright light Evaluation: Evaluate pt response to anticholinergic Determine whether constipation, urinary retention, or increase pulse rate is or remains a problem

what interventions need to be in place for methylphenidate?

Give before breakfast and lunch Report irregular heartbeat Record height, weight, and growth of children Avoid alcohol, caffeine - read labels on OTC products Use sugarless gum to relieve dry mouth Do not stop abruptly; taper off to avoid withdrawal symptoms Counseling must also be used Monitor sleep habits and patterns Watch & report known side effects Watch for onset of Tourette's syndrome

Contra for anticolinergics?

Gluacoma

What adverse reactions would a nurse monitor after giving Albuterol?

Hallucinations and cardiac dysarrthymias

what side effects would a nurse suspect when a adrenergic agonist is given?

Hypertension Tachycardia Palpitations Restlessness Tremors Dysrhythmias Dizziness Urinary retention Nausea, vomiting Dyspnea Pulmonary edema

Doxapram- uses, onset, se

Respiratory depression caused by overdose, pre- and post anesthetic respiratory depression, and chronic obstructive pulmonary disease (COPD) Use with caution for the treatment of neonatal apnea Onset of action 20 to 40 seconds, peak within 2 minutes Side effects Hypertension, tachycardia, trembling, convulsions

A nurse is teaching a patient who will receive chemotherapy that will cause thrombocytopenia. Which instructions will the nurse include in the patient's teaching plan? (Select all that apply.) a. Use an electric razor when shaving. b. Use a soft-bristled toothbrush. c. Use aspirin for pain or headache. d. Monitor oral temperature daily. e. Report any bleeding (gums, petechiae, bruises, hematuria, melena) to the health care provider.

a,b,e

A patient is experiencing mucositis (stomatitis) after receiving chemotherapy. Which symptomatic treatments will be appropriate? (Select all that apply.) a. Frequent mouth rinses b. Antiemetics c. Topical anesthetics d. Stress reduction e. Antibiotics

a,c,e

Which of the following patients would Albuterol work on? A) at pt with a pulse at 56 B) A patient on Epinephrine C) PT on MAO inhibitors D) A pt who has just be given acetaminophen E) a patient who just took tricyclic antidepressants F) A patient who is on beta blockers

a,d

A pt is diagnoised with Parkinson's disease. What drugs may be prescribed? A)benztropine (Cogentin) B)biperiden (Akineton) C) Atropine D) trihexyphenidyl HCl (Artane) E) Benedictines

a.b.d

what adverse reactions would a nurse want educate a pt about on methylphenidate?

achycardia, hypertension, growth suppression, palpitations, seizures, transient weight loss in children Life threatening: Exfoliative dermatitis, stroke, thrombocytopenia, hepatotoxicity

A pt reports nausea after her last round of chemo. What nursing actions would the nurse take?

administer antiemetic before next chemo administration monitor nutrition, encouraging small high protein meals

Which of the following are normal symptoms for Filgrastim?a)GI distress, B)chest pain C)alopecia, d)fever, E)fatigue, F) disarrthmia G)dyspnea, cough, headache, stomatitis.

all but b and f

What should a nurse educate a patient about when they have alopecia related to chemo treatment?

avoid sunlight and use suncreen

A patient is scheduled to receive high-dose cyclophosphamide via an intravenous infusion as treatment for cancer. Which will be most important for the nurse to include when teaching the patient about cyclophosphamide? a. An indwelling urinary catheter will be placed. b. Drink at least 2 L of fluid per day. c. Empty the bladder every 4 to 6 hours. d. Limit fluid intake during chemotherapy.

b

A patient is to receive a chemotherapy protocol that includes an alkylating agent, an antimetabolite, and an antitumor antibiotic. The patient asks the nurse why so much chemotherapy is needed. What is the nurse's best response? a. A protocol that uses a combination of chemotherapeutic agents works in the S phase to kill cells. b. Combination chemotherapy increases the extent of tumor cell killing. c. Combination chemotherapy uses drugs that work the same way. d. An outcome of the use of combination chemotherapy is that it has no dose-limiting toxicities.

b

A pt is prescribed an alpha 1 receptor agonist. What would the nurse know is going to be affected in the pt?

blood vessels (constriction, inc. BP etc) eyes dilated relaxed bladder contractions in prostate

A nurse is administering doxorubicin to a patient in the outpatient oncology clinic. Which information would be most important for the nurse to include in patient teaching? a. Blood counts will most likely remain normal. b. Complete alopecia rarely occurs with this drug. c. Report any shortness of breath, palpitations, or edema to the health care provider. d. Tissue necrosis usually occurs 2 to 3 days after administration

c

A patient diagnosed with cancer is scheduled to receive vincristine. Which nursing assessment will have the highest priority when providing care for this patient? a. Degree of alopecia b. Increased digoxin levels c. Decreased phenytoin effects d. Peripheral neuropathy

c

A patient in the outpatient oncology clinic has developed mucositis after receiving fluorouracil. Which statement made by the patient indicates the need for additional teaching about mucositis? a. I will frequently rinse out my mouth with normal saline. b. To relieve my mouth pain, I will use ice pops or ice chips. c. I will use mouthwash with alcohol to clean my mouth. d. Using a soft toothbrush will clean my teeth and freshen my breath

c

A patient taking Doxorubicin says that their urine is red. What should the nurse respond to this? a) we need to do kidney testing right away b) this is an adverse reaction c) this is a normal symtoms of this antitumor medication d) none of the above

c

What does a nurse suspect to be prescribed to a patient with ADHD or narcolepsy?

methylphenidate (Ritalin)

A woman comes in and reports to falling asleep suddenly without warning. This has happened to her at work and while cooking and is worried that it will continue to get worse. What does the nurse suspect is the underlying cause?

narcolepsy

What does a nurse need to do before adminestering interferons?

note all interactions! Watch during adminitstration

Nonbenzo for hypnotic

zolpidem (Ambien) Action Neurotransmitter inhibition Its duration of action is 6 to 8 hours with a short half-life of 2 to 4.5 hours. Use Treat short-term (less than 10 days) insomnia