Pharm- Week 1

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epoetin alfa indications

-acts like the natural glycoprotein erythropoietin to stimulate the production of RBCs in the bone marrow -tx for anemia associated with renal failure; and patients on dialysis, AIDS therapy, and cancer chemotherapy when the bone marrow is depressed and the kidneys may be affected by toxic drugs (Procrit only) -3 times a week administration

The nurse is caring for a patient who is beginning treatment for benign prostatic hyperplasia and knows that this patient may be treated with which classification of drugs? (Select all that apply.)

-testosterone blockers -Alpha adrenergic

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor? A) Sodium levels B) Bone narrow function C) Calcium levels D) Potassium levels

Methenamine

*Suppresses or eliminates bacteria associated with UTIs and anatomical abnormalities* Makes the urine acidic, good for children

Fosfomycin

*Treats UTIs caused by susceptible bacteria* ; give one dose in patients who are 18 years and below.

*Urinary tract infections* are treated with *two* types of *anti-infectives* , which are *______________* that *kill bacteria* and medications that *__________* *the urine*.

Antibiotics Acidify

The nurse is evaluating the effectiveness of flavoxate (Urispas). Which report by the patient indicates the drug has been effective?

"I slept uninterrupted through the night."

Which statement by a 62-year-old client indicates that the client understands the nurse's teaching about diuretics? - "I will have to limit my high sugar foods." - "If my legs get swollen again, I'll take an additional pill." - "I will weigh myself daily and report significant changes." - "I will take my medication before bedtime on an empty stomach."

"I will weigh myself daily and report significant changes."

A 48-year-old client needs additional teaching regarding anticoagulants if the client states: - "I can use an electric razor." - "I will carry a MedicAlert card." - "I'll use aspirin for arthritis pain." - "I should have labs drawn once a month.:

"I'll use aspirin for arthritis pain."

A client diagnosed with iron deficiency anemia is learning about her prescribed iron supplement. Which additional information would the nurse include in the client's teaching plan?

"If constipation or diarrhea become severe, call your primary care provider."

A 22-year-old female client is seen in the primary care provider's office for a follow-up visit. Six weeks ago she was diagnosed with iron deficiency anemia and has been taking the prescribed iron supplement. She noticed that her stool has turned black. She tells the nurse she fears that she is bleeding to death inside her belly. The nurse teaches the client about which expected outcome? (Ch 49) - "Iron supplements cannot cause bleeding." - "Black stool is not a sign of internal bleeding." - "Iron supplements may cause bleeding, but this is nothing to worry about." - "Iron supplements can cause black or dark stools because of the iron composition."

"Iron supplements can cause black or dark stools because of the iron composition." Rationale: The iron preparations stain the stools; the color remains as long as you are taking the drug and should not cause concern. The most common adverse effects associated with oral iron are related to direct GI irritation. (pg 871)

A client who is taking phenazopyridine (Pyridium) for urinary analgesia along with nitrofurantoin calls the clinic to report that her sclera appears yellowish. What is the nurse's best response to this client? a) "Come immediately to the clinic to be checked for hepatitis." b) "This is a result of the urinary tract infection and will go away once you have completed your anti-infective." c) "Phenazopyridine can cause your skin and your sclera to develop a yellowish discoloration." d) "Stop taking the nitrofurantoin and the health care provider will prescribe another medication."

"Phenazopyridine can cause your skin and your sclera to develop a yellowish discoloration."

Phenazopyridine

*Relieves symptoms of discomforts associated with urinary tract trauma or infection* changes the urine reddish-orange

A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman?

"You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued."

Trospium can cause elevated serum levels of what 4 drugs that are commonly given to patients with certain chronic diseases such as diabetes, HF, chronic pain?

- morphine - digoxin - metformin - tenofovir

urinary frequency

- the needs to void often - usually seen in response to irritation of the bladder, age and infammmaton

A client is receiving epoetin alfa. The nurse understands that this drug's duration of effect would be which amount of time?

24 hours

The amount of fluid excreted as urine each day averages approximately less than how many liters?

A pt has been prescribed Darbepoietin alfa 0.45 mcg/kg IV once per week. The pt weighs 185 lb. How many micrograms of the medication should the nurse administer? Provide your response to the nearest microgram.

38 mcg

Prototype Summary: Spironolactone Actions:

Competitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium.

A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg/d. The child weighs 76 pounds. How many mg does the child receive in each dose? A) 20 mg B) 50 mg C) 105 mg D) 210 mg

This hormone is released by the pituitary when the sodium concentration of blood rises.

ADH

Prototype of CARBONIC ANHYDRASE INHIBITORS

Acetazolamide

Prototype Summary: Hydrochlorothiazide Indications:

Adjunctive therapy for edema associated with heart failure, cirrhosis, corticosteroid or estrogen therapy, and renal dysfunction; treatment of hypertension as monotherapy or in combination with other antihypertensives.

Prototype Summary: Acetazolamide Indications:

Adjunctive treatment of open-angle glaucoma, secondary glaucoma; preoperative use in acute angle-closure glaucoma when delay of surgery is indicated; edema caused by heart failure; and drug- induced edema.

Adverse Effects of Folic Acid (Prototypes of Folic Acid Derivatives or Vitamin B12)

Allergic reactions, pain and discomfort at injection site.

agents treating megaloblastic anemia Adverse Effects Folic Acid Derivatives

Allergic reactions, pain and discomfort at injection site.

Drugs for Treatment of Bening Prostatic Hyperplasia

Alpha-adrenerci blockers: - alfuzosin - doxazosin - tamsulosin - terazosin

A nurse is planning care for a client who is taking tolterodine. Which is an appropriate nursing diagnosis that is an indication for using this drug?

Altered Urinary Elimination related to overactive bladder

A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication? A) Hypokalemia B) Hyperkalemia C) Gastric irritation D) Hypertension

RBCs must be continually produced by the body because: A) The iron within the RBC wears out and must be replaced B) RBCs cannot maintain themselves and wear out C) RBCs are continuously entering and being lost from the GI tract D) RBCs are processed into bile salts and must be replaced

Doxazosin (Cardura) is used for treatment of ?

BPH

A nurse is caring for a hospitalized client with a urinary tract infection (UTI). The nurse is preparing to administer nitrofurantoin, which is a bacteriostatic antibiotic. Which statement best differentiates bacteriostatic and bactericidal medications?

Bacteriostatic medications slow or retard the multiplication of bacteria

*Enlarged prostate* is called *____________* *___________* *___________*

Benign Prostate Hypertrophy (BPH)

Adverse effects of Pentosan Polysulfate Sodium?

Bleeding, headache, alopecia, & Gastrointestinal Disturbances

Norvoflaxin & Fosymacin

Both are antibiotics, used for gram negative bacteria

The nurse should advise patients taking phenazopyridine (Pyridium) that their urine may become discolored, which of the following colors? (Choose one) a) Green b) Brown c) Purple d) Blue

Brown

A patient has just been prescribed furosemide (Lasix). After reviewing the patient's medication history, what drug would cause the nurse concern when taken with furosemide (Lasix)? A) Acetaminophen B) Ferrous sulfate (Feosol) C) Naproxen sodium (Naprosyn) D) Ampicillin

A pt develops anemia secondary to chronic hemodialysis. The health care provider prescribes iron sucrose. The nurse expects this drug to be administered by which route? A) Oral B) Subcutaneous C) Intravenous D) Intramuscular

A pt has been receiving intramuscular injections of Hydroxocobalamin as treatment for pernicious anemia. Which statement by the pt indicates an understanding of the therapy? A) Once my levels are up, I won't need the drug anymore B) I will get the injection for a week and then stop C) I will need these injections monthly for the rest of my life D) I need the injections now, but then I can switch to a pill

A patient comes to the clinic for a 1-month follow-up appointment. The patient tells the nurse he or she has been taking chlorothiazide (Diruil) for a month and now has leg cramps and "feels tired all the time." What will the nurse consider as the cause of the patient's symptoms? A) Hypercalcemia B) Hypocalcemia C) Hyperkalemia D) Hypokalemia

SATA. The nurse teaches the pt prescribed iron therapy to allow at least 2 hours to lapse before or after taking what? A) Ranitidine B) Chloramphenicol C) Antacids D) Norfloxacin E) Tetracycline

C D E

SATA. What would a nurse identify as contraindications for iron therapy? A) Esophageal varices B) Gastroesophageal reflux C) Hemolytic anemia D) Colitis E) Peptic ulcer disease

C D E

A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)? A) To decrease the action of the renin-angiotensin cycle B) To make more concentrated plasma C) To dilute the urine D) To avoid rebound edema

Who takes Nitrofurantoin?

Chronic UTI

The nurse is providing health teaching to a 62-year-old female patient who has been started on an anti-infective. This patient should be taught to contact her physician if she experiences what adverse effect?

Confusion

What occurs as a result of a defect in the renal system's countercurrent mechanism process?

Electrolyte imbalance

folic acid (generic)

Folic Acid Derivative 1) replacement therapy and treatments of megaloblastic anemia 2) oral, IM, IV, and subcutaneous

Prototype Summary: Spironolactone Adverse Effects:

Dizziness, headache, drowsiness, rash, cramping, diarrhea, hyperkalemia, hirsutism, gynecomastia, deepening of the voice, irregular menses.

Prototype of Erythropoiesis-Stimulating Agents

Epoetin Alfa

True or False: Folic acid is necessary for cell growth and maintenance of the myelin sheath.

False; Folic acid is necessary for cell growth and development; vitamin B12 is necessary for maintenance of the myelin sheath

PROTOTYPE OF THIAZIDE AND THIAZIDE-LIKE DIURETICS

Hydrochlorothiazide

Prototype Summary: Mannitol Route:

IV, Irrigant

Which would a nurse identify as the primary issue associated with anemias? a)Lack of vitamin B12 b)Increased plasma proteins c)Defective white blood cells d)Ineffective red blood cells

Ineffective red blood cells

What action dose Pentosan Polysulfate Sodium have?

It adheres to and coats the bladder mucosal wall to protect it from irritation related to solutes in the urine

Adverse Effects of Hydroxocobalamin (Vitamin B12)

Itching, transitory exanthema, mild diarrhea, anaphylactic reaction, heart failure, pulmonary edema, hypokalemia, pain at injection site.

Actions of Epoetin Alfa (Prototype of Erythropoiesis-Stimulating Agents)

Natural glycoprotein that stimulates red blood cell production in the bone marrow.

Which drug is aUTI anti-infective?

Nitrofurantonin

Prototype Summary: Hydrochlorothiazide Route:

Oral

Indications of Ferrous Sulfate (Prototype of Iron Preparations)

Prevention and treatment of iron deficiency anemia; dietary supplement for iron.

How does the renal system maintain and regulate serum calcium levels?

Regulating vitamin D activation

Which nursing diagnosis is highest priority for a patient with history of urinary urgency who is taking oxybutynin (Ditropan)?

Risk for impaired urinary elimination

Which drug is an Alpha- Adrenergic Blocker

Tamsulosin

Salicylate

The diuretic effects decrease when K+ sparing diuretics are given with what?

Which substances are moved from the glomerulus into the tubule due to hydrostatic pressure?

Water *The glomerulus acts as an ultrafine filter for all of the blood that flows into it. The semipermeable membrane keeps lipids, proteins, and blood cells inside the vessel, whereas the hydrostatic pressure from the blood pushes water and smaller components of the plasma into the tubule.

Weigh every day at the same time in the same clothes

When a patient discharges home on a diuretic, what should s/he be taught to do?

chlorothiazide

Which thiazide can be given IV

Because it is not potassium saving- and diuretics in general can elevate sugars/glucose

Why can thiazide diuretics lead to hypokalemia and increased blood glucose?

Why should the Adrenergic blockers not be used with caution in patients with heart failure or known coronary disease?

because it can aggravate the conditions and cause a drop in blood pressure or tachycardia.

Urinary Tract Analgesic

phenazopyridine

Which drug would the nurse identify as turning a client's urine reddish orange?

phenazopyridine

A nurse is seeing a client who has been prescribed phenazopyridine in combination with an antibacterial medication to treat a urinary tract infection. What is important for the nurse to tell the client about this treatment?

do not take this medication for more than two days

Which would be appropriate for a client who is receiving iron therapy? a)Ensuring that the client consumes three large meals per day b)Advising the client to limit the amount of fiber in his diet c)Cautioning the client that stool may be dark or green d)Encouraging the client to take the drug on an empty stomach

cautioning the client that stool may be dark or green

interstitial cystitis

chronic inflammation of the interstitial connective tissue of the bladder

Urinary Tract Anti-Infectives

cinoxacin fosfomycin methenamine methylene blue nitrofuration norfloxacin

A client is started on trimethoprim and sulfamethoxazole for a urinary tract infection. The client reports nausea, anorexia, and abdominal pain. What intervention does the nurse discuss with the client?

consume the medication with food

osmotic pull

drawing force of large molecules on water, pulling it into a tubule or capillary; essential for maintaining normal fluid balance within the body; used to draw out excess fluid into the vascular system or the renal tubule

The nurse would caution the client to avoid driving if which adverse reaction of urinary tract anti-infectives occur?

drowsiness

Drugs that Block Testosterone Production

dutasteride finasteride

A patient with benign prostatic hypertrophy is receiving treatment with finasteride (Proscar). What is an appropriate patient instruction?

do not let your wife handle the pills

Erythropoiesis stimulating agents

darbepoetin alfa (Aranesp) epoetin alfa (Epogen) epoetin alfa (Procrit) They are for patients who are no longer able to produce enough erythropoietin in the kidneys.

Urinary Tract Antispasmodics

darifenacin fesoterodine flavoxate oxybutynin solifenacin tolterodine trospium

Pentosan Polysulfate Sodium is primarily used to?

decrease pain and discomfort associated with interstitial cystitis

Anemia

disorder involving too few RBCs or ineffective RBCs that can alter the blood's ability to carry oxygen.

anemia

disorder involving too few red blood cells (RBCs) or ineffective RBCs that can alter the blood's ability to carry oxygen

hyperaldosteronism

excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium (aldosterone= reabsorbs water/salt)

Phenazopyridine action is to?

exert a direct topical analgesic effect on the urinary tract mucosa that releases burning, urgency, frequency, pain and discomfort

erythropoietin

glycoprotein produced by the kidneys, released in response to decreased blood flow or low oxygen tension in the kidney; stimulates RBC production in the bone marrow

Adverse effects of the alpha-adrenergic blockers include?

headache, fatigue, dizziness, postural dizziness, lethargy, tachycardia, hypotension, GI upset, and sexual dysfunction

agents treating sickle cell anemia prototype

hydoxyurea (Droxia)

Agent for Sickle Cell Anemia (also treated with antibiotics & pain-relieving activities)

hydroxyurea (Droxia): a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer, and melanoma

pyelonephritis

inflammation in the pelves of the kidney - frequently caused by back flow problems or by bacteria ascending the ureter

cystitis

inflammation of the bladder caused by infection or irritation

A client has been diagnosed with genital warts. Which medication would the nurse anticipate being prescribed?

interferon alfa-2b

Erythropoiesis-Stimulating Agents adverse effects

most common: CNS effect --> result from cellular response to glycoprotein -HA -fatigue -dizziness -asthenia (loss of strength) -seizure CV effects --> RT increase in RBC # -HTN -edema -possible chest pain -DVT & rapid growth of tumor cancer when hemoglobin is higher than 11 g/dL -pure red cell aplasia associated with erythropoietin-neutralizing antibodies can occur

agents treatingIron deficiency anemia adverse effects

most common: direct GI irritation -anorexia -GI upset -constipation -dark or green stools -increase bulk foods -iron toxicity can cause coma & death parenteral iron associated with: -severe anaphylactic rx's -local irritation -staining of tissue -phlebitis (z-track method) -ferumoxytolis a super magnetic resonance imaging (MRI) & interruption for up to 3 months

edema

movement of fluid into the interstitial spaces; occurs when the balance between osmotic pull (from plasma proteins) and hydrostatic push (from blood pressure) is upset

A nurse should not administer solifenacin (Vesicare) to a patient with which medical condition?

myasthenia gravis

Which nursing observation is an appropriate outcome to indicate effective anti-infective therapy for a urinary tract infection?

negative urinalysis

Erythropoiesis-Stimulating Agents D2D

never mixed with drugs or solutions bc of risk of interaction with solution

The nurse is seeing a pregnant client who has a confirmed urinary tract infection that requires treatment. Which anti-infective medication should the nurse anticipate will be prescribed for this client?

nitrofurantoin

What older anti-invectives have established pediatric guidelines?

nitrofurantoin methenamine

The nurse is discussing the effects of doxazosin (Cardura) with a 65-year-old man who has just been diagnosed with benign prostatic hyperplasia (BPH). The patient asks the nurse whether the drug will make him impotent. After the discussion with the patient, the nurse determines that a potential priority nursing diagnosis could be what?

noncompliance

agents treatingIron deficiency anemia food interaction

not absorbed with -milk -eggs -antacids -coffee -tea

A client is to receive methenamine. The nurse anticipates administering this drug by which route?

oral

high-ceiling diuretics

powerful diuretics that work in the loop of Henle to stop the reabsorption of sodium and chloride, lead- ing to a sodium-rich diuresis

erythropoiesis

process of RBC production and life cycle; formed by megaloblastic cells in the bone marrow, using iron, folic acid, carbohydrates, vitamin B12, and amino acids; they circulate in the vascular system for about 120 days and then are lysed and recycled

Erythropoiesis

production of red blood cells

The part of the nephron that drains into the nephron loop is the:

proximal tubule

For which disorder would treatment with an anti-infective be appropriate?

pyelonephritis

The nurse knows that urinary anti-infectives are chosen to treat bladder infections because of what property?

rapid excretion rate

A clinic patient has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This patient should be informed that Pyridium will turn urine what color?

reddish-orange

Hydroxyurea (Droxia) Therapeutic Actions & Indications

reduction of frequency of painful crises and to decrease the need for blood transfusions in adults with sickle cell anemia; taken for several months to increase the amount of fetal hemoglobin produced in the bone marrow and dilutes the formation of the abnormal hemoglobin S in adults who have sickle cell anemia - given orally

fluid rebound

reflex reaction of the body to the loss of fluid or sodium; the hypothalamus causes the release of antidiuretic hormone, which promotes water retention, and stress related to fluid loss combines with decreased blood flow to the kidneys to activate the renin-angiotensin-aldosterone system, leading to further water and sodium retention

plasma

the liquid part of the blood; consists mostly of water and plasma proteins, glucose, and electrolytes

Acidification

the process of increasing the acid level - used to treat bladder infections - makes bladder an undesirable place for bacteria

Signs of UTI's

urinary frequency urgency burning on urination chills fever flank pain tenderness (associated with acute pyelonephritis)

A 50-year-old female client who has pernicious anemia asks you why vitamin B12 must be administered parenterally. What is the best response to her question? (Ch 49) - "Oral forms of vitamin B12 will not be absorbed." - "Oral ingestion of vitamin B12 causes irritation and bleeding." - "With severe deficiencies like yours, oral vitamin B12 is not effective." - "Pernicious anemia causes changes in the mucous membranes lining and impairs absorption."

"Oral forms of vitamin B12 will not be absorbed." Rationale: Parenteral drugs are preferred for patients with potential absorption problems; all other patients should be given the oral form if possible. (pg 873) Vitamin B12 is essential for cell growth and division and for the production of a strong stroma in RBCs. It is also necessary for maintenance of the myelin sheath in nerve tissue. Vitamin B12 is given as replacement therapy for dietary deficiencies, as replacement in high-demand states such as pregnancy and lactation, and to treat megaloblastic anemia. (pg 872-873)

The nurse is teaching a pt diagnosed with renal failure who will begin receiving Epoetin alfa. What education should the nurse prioritize? A) Teaching the pt to self-administer subcutaneous injections B) Teaching the pt about the need for administration at the same time each morning C) Teaching the pt how to adjust the dose based on symptoms severity D) The need to limit sun exposure or wear sunscreen during treatment

The nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient? A) Impaired urinary elimination B) Monitor the patient response to the drug C) Imbalanced nutrition: More than body requirements D) Risk for fluid volume overload

The nurse suspects the pt has what type of anemia upon learning that the pt take Hydroxyurea? A) Sickle cell anemia B) Anemia of renal failure C) Iron deficiency anemia D) Anemia secondary to cancer chemotherapy

The pt, diagnosed with anemia, asks that that means. The nurse best explains the disorder by saying anemia is characterized by what? A) Altered red blood cell production or function B) Decreased levels of platelets C) A deficiency of vitamin B12 D) A deficiency in cellular ability to metabolize glucose

What statement by the 62-year-old patient indicates that the patient understand the nurse's teaching about diuretics? A) "I will weigh myself daily and report significant changes." B) "I will have to limit my high sugar foods." C) "If my leg gets swollen again, I'll take an additional pill." D) "I will take my medication before bedtime on an empty stomach."

To ensure maximum absorption a nurse instructs a pt receiving oral iron therapy to avoid taking the iron with: A) Protein B) Antibiotics C) Dairy products D) Any other drugs

*Pain or discomfort* when *voiding* is called *____________*

Dysuria

The client has been prescribed nicotinic acid for treatment of hyperlipidemia. The nurse should teach about which common side effects with the medication? - Fever - Facial tics - Drowsiness - Flushing of the skin

Flushing of the skin

Prototype of OSMOTIC DIURETICS

Mannitol

The pharmacology students are learning about medications used to treat urinary tract problems. What symptoms does phenazopyridine treat?

Pain and Urgency

*____________* *_______________* *___________* is used to *decrease pain* and *discomfort* in patients with *interstitial cystitis*.

Pentosan polysulfate sodium(Elmiron)

Which drug is a urinary analgesic?

Phenazophyridine

The pathophysiology instructor is talking to the pre-nursing students about hypovolemia and the kidneys. The instructor points out that when the blood pressure is low due to dehydration the body will compensate by secreting:

Renin *Regulation of blood pressure is also a function of the kidney. Specialized vessels of the kidney called the vasa recta constantly monitor blood pressure as blood begins its passage into the kidney. When the vasa recta detect a decrease in blood pressure, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II, the most powerful vasoconstrictor known. The vasoconstriction causes the blood pressure to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in blood pressure. When the vasa recta recognize the increase in blood pressure, renin secretion stops. Failure of this feedback mechanism is one of the primary causes of hypertension.

*Trospium*(Detrol) is designed to treat bladder *___________* that cause *urinary* *frequency* and *urgency*.

Spasms

What is the focus of the renal system's renin-angiotensin- aldosterone system?

The regulation of blood pressure

What best describes the structure of the kidneys?

The renal pelvises drain urine into the ureters. *The renal pelvises drain the urine into the ureters. All nephrons filter and make urine, but only the medullary nephrons can concentrate or dilute urine. The renal arteries come directly off the aorta. Erythropoietin is produced by a small group of cells called the juxtaglomerular apparatus.

A 72-year-old man presents at a blood donor drive. The patient tells the nurse he donates blood on a regular basis. While reviewing the patient's medication history, the nurse notes he is taking finasteride for his benign prostatic hyperplasia (BPH). What would the nurse know is a contraindication to this patient giving blood?

The testosterone blocking effects will be passed to those receiving the blood.

Urinary anti-infectives are used only to treat urinary tract infections (UTIs). What causes urinary anti-infectives to be so effective in treating UTIs?

They act specifically within the urinary tract.

A patient with benign prostatic hypertrophy (BPH) has been prescribed an alpha-adrenergic blocker. How do alpha-adrenergic blockers, such as Tamsulosin, assist in treating the symptoms of BPH?

They inhibit contraction of the urinary bladder.

Indications of Epoetin Alfa (Prototype of Erythropoiesis-Stimulating Agents)

Treatment of anemia associated with chronic renal failure, related to treatment of HIV infection or to chemotherapy in cancer patients; to reduce the need for allogenic blood transfusions in surgical patients.

Elevated uric acid

What causes gout?

Which client population would benefit most from education of minimizing the risk for the development of cystitis?

a female client *The shorter female urethra leads from the urinary bladder to the outer body into an area rich in gram-negative bacteria. Cystitis, or infection of the urinary bladder, is a common problem for women.

Erythropoietin

a glycoprotein secreted by the kidneys that stimulates the production of red blood cells in the bone marrow

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?

a patient with cancer

antispasmodics

agents that block muscle spasm associated with irritation or neurological stimulation

If an antispasmodic is need for children older than 5 years of age what antispasmodic is indicated for use?

oxybutynin

dysuria

painful urination

Bladder Protectant

pentosan polysufate sodium

A client has been taking a urinary tract anti-infective for two days for treatment of a severe urinary tract infection. Today, the client calls the clinic complaining of continued burning on urination. What is the nurse's best response? a) "All of your urinary symptoms should have stopped immediately after you started taking the medication. Are you sure you are taking it correctly?" b) "You must have a very severe infection. Come back to the clinic and we will give you your medication intravenously." c) "The medication is not working. Stop taking it and drink cranberry juice." d) "Burning on urination is a common side effect of these drugs. This may continue the entire time that you are on the medication."

"Burning on urination is a common side effect of these drugs. This may continue the entire time that you are on the medication."

A client who is taking phenazopyridine and nitrofurantoin for treatment of a urinary tract infection calls the clinic to report a yellowish discoloration of the skin. What is the nurse's best response to this client?

"I will let the health care provider know immediately."

A nurse is describing the reasons why more women than men are affected by cystitis. Which would the nurse identify as a major reason?

"The urethra exits into an area rich in gram-negative bacteria." *In the female, the urethra is a very short tube that leads from the bladder to an area populated by normal flora, including Escherichia coli, which can cause frequent bladder infections or cystitis. In the male, the urethra is much longer and passes through the prostate gland, a small gland that produces an alkaline fluid that is important in maintaining the sperm and lubricating the tract. Neither the prostate nor the fluid has any effect on the development of cystitis. The urinary bladder does stretch, but the amount of stretch is highly variable.

A client is receiving heparin IV and has been started on warfarin. The client asks the nurse why she is taking both medications. What is the nurse's most accurate response? - "You will need both warfarin and heparin for several days." - "After a certain period of time, you must start warfarin and heparin together." - "Warfarin cannot be given without heparin due to the amount of clotting you need." - "Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."

"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."

Dutasteride

*A long term treatment for BPH to shrink the prostate and relieve the symptoms of hyperplasia* blocks testerone due to dutasteride

Oxybutynin

*Acts directly to relax smooth muscle in the bladder*, inhibits the effects of actylcholine at muscarinic receptors *Relieves sx of bladder instability*

Bladder Protectant

*Sticks to the bladder wall and acts as a buffer to control cell permeability; the protectant prevents irritating solutes in the urine from reaching the bladder wall cells* Decreases pain/discomfort associated with interstitial cystitis

Tolterodine toxicity can occur if it is taken with what other drug or type of drugs?

- CYP2D6 inhibitors - fluoxetine - reduce amount of tolterodine given if combination is needed

Toxic effects of solifenacin may be seen if it is combined with what other drug or types of drugs?

- Ketoconazole - any cytochrome P45p3A4 inhibitors (CPY3A4)

Ocybutynin is an antispasmodic, what should a nurse assess a patient for when they are on an antispasmodic?

- LOC - orientation - reflexes (especially CNS) - Urinary elimination pattern - pain w/urnation - difficulty voiding - vital signs (pulse included) - abnormal urinalysis, urinary cultures - renal and hepatic function (toxicity)

Solifenacin causes prolonged QT intervals and other serious cardiac arrhythmias if combined with what other drugs?

- any other drug that prolongs the QT interval - antihistamines, antipsychotics - if such combination is used closely monitor pt.

Benign prostatic hyperplasia

- enlargement of the prostate gland - associated with age and inflammation - also called benign prostatic hypertrophy

urgency

- feeling that one needs to void immediately - associated with infection and inflammation of the urinary tract

nocturia

- getting up to void at night - caused by increased renal perfusion with fluid shifts while in the supine position and gravity-dependent edema related to heart failure shifts back into blood supply - may also be caused by urinary infection or an inflamed urinary tract

Trospium

- newest drug for urinary tract spasms - only drug specifically indicated for treatment of overactive bladder w/symptoms of urinary incontinence, urgency, and urinary frequency

darbepoetin alfa indications

- treats anemias associated with chronic renal failure, including patients receiving dialysis; also for tx of anemia induced by cancer chemotherapy -once-weekly administration - bad publicity bcs athletes used it to increase their RBC count to get more endurance and strength

Oxybutynin

- treats symptomatic urinary bladder spasm and overactive bladder - acts directly to relax smooth muscle in the bladder - inhibits effects o acetylcholine at muscarinic receptors

etiology of anemia

-Anemia can occur if erythropoietin levels are low. -This is seen in renal failure, when the kidneys are no longer able to produce erythropoietin -To produce healthy RBCs the bone marrow must have: 1.Adequate amount of iron, used in forming hemoglobin rings to carry O2 2.Vitamin B12 and folic acid to form a strong supporting structure that can survive being battered through blood vessels for 120 days 3.Essential amino acids and carbs to complete hemoglobin rings, cell membranes, and basic structure

You are preparing a plan of care for a 78-year-old female patient who has been hospitalized with a recurrent urinary tract infection (UTI). What would be important to assess for before administering a urinary tract antispasmodic? (Select all that apply.)

-Glaucoma -Pyloric Obstruction -Duodenal Obstruction

A 77-year-old man has been placed on tamsulosin for his benign prostatic hyperplasia (BPH). The nurse explains to the patient that because of the medication he is taking, it will be necessary to monitor for what? (Select all that apply.)

-ICP -Blood Pressure -Bladder Emptying

agents treatingIron deficiency anemia contraindication

-allergy -hemochromatosis (Excessive iron) -hemolytic anemia --> increase serum levels cause toxicity - normal iron balance --> drug will not be absorbed and will just pass through the body -peptic ulcer, colitis, or regional enteris --> bc drug can be directly irritating to these tissues & can cause exacerbayion of disease; oral won't be effective

The nurse is caring for a patient with a bladder infection. What symptoms are most common with this type of infection? (Select all that apply.)

-frequency -urgency -dysuria

agents treatingIron deficiency anemia D2D

-iron absorption decreased if iron preparations are taken with --> antacids, tetracyclines, or cimetidine (take 2 hrs apart) -acidic liquid increase absorption -anti-infective response to ciprofloxacin can decrease if these drugs are taken wit iron bc of a decrease in absorption (take 2 hrs apart) -iron levels increase with --> chlormaphenicol (monitor for toxicity) -effects of levodopa may decrease with iron (take 2 hrs apart)

Urinary tract infections (UTIs) in children do occur. If a child has repeated UTIs, what would be important to assess for? (Select all that apply.)

-obstruction -sexual abuse -bubble bath

agents treatingIron deficiency anemia pharm

-pain with IM injection (Z-track) -PO lost in feces -A: small intestine by active transport -can take 2-3 weeks to see improvement & 6-10 months for return of stable iron level

agents treating megaloblastic anemia pharm Folic Acid Derivatives

-parenteral drugs are preferred for pts with potential absorption problems -M: liver E: urine

ferrous fumarate

1) agent used for iron deficiency anemia 2) available for oral administration; 2-3 weeks to see results 3) Contraindications: hemochromatosis; hemolytic anemias; peptic ulcers, colitis, or regional enteritis 4) Adverse Effects: GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation 5) antacids, tetracyclines, cimetidine decrease absorption of the iron drugs; iron is not absorbed if taken with eggs, mild, coffee, or tea, acidic liquids may enhance the absorption

ferrous gluconate

ferrous sulfate

ferrous sulfate exsiccated

iron dextran

1) agent used for iron deficiency anemia 2) parenteral form of iron given by Z-track method; for GI absorption problems; 2-3 weeks to see results 3) Contraindications: hemochromatosis; hemolytic anemias; peptic ulcers, colitis, or regional enteritis 4) severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis 5) antacids, tetracyclines, cimetidine decrease absorption of the iron drugs; iron is not absorbed if taken with eggs, mild, coffee, or tea, acidic liquids may enhance the absorption

ferumoxytol

1) agent used for iron deficiency anemia in adults with chronic renal failure 2) IV; 2-3 weeks to see results 3) Contraindications: hemochromatosis; hemolytic anemias; peptic ulcers, colitis, or regional enteritis 4) severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis; a super-magnetic iron oxide that can alter magnetic resonance imaging (MRI) images and interpretation for up to 3 months 5) antacids, tetracyclines, cimetidine decrease absorption of the iron drugs; iron is not absorbed if taken with eggs, mild, coffee, or tea, acidic liquids may enhance the absorption

iron sucrose

1) agent used for iron deficiency anemia in patients undergoing chronic hemodialysis or nondialysis patients with renal failure who are also receiving supplemental erythropoietin therapy 2) IV; 2-3 weeks to see results 3) Contraindications: hemochromatosis; hemolytic anemias; peptic ulcers, colitis, or regional enteritis 4) severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis 5) antacids, tetracyclines, cimetidine decrease absorption of the iron drugs; iron is not absorbed if taken with eggs, mild, coffee, or tea, acidic liquids may enhance the absorption

sodium ferric gluconate complex

1) agent used for iron deficiency anemia in patients undergoing chronic hemodialysis who are also receiving supplemental erythropoietin therapy 2) IV; 2-3 weeks to see results 3) Contraindications: hemochromatosis; hemolytic anemias; peptic ulcers, colitis, or regional enteritis 4) severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis 5) antacids, tetracyclines, cimetidine decrease absorption of the iron drugs; iron is not absorbed if taken with eggs, mild, coffee, or tea, acidic liquids may enhance the absorption

cyanocobalamin (Nascobal)

1) replacement therapy for Vitamin B12; treatment of megaloblastic anemia 2) intranasal gel; used once a week in one nostril 3) should be used with caution in the presence of nasal erosion or ulcers 4) nasal irritation

hydroxocobalamin (generic)

1) replacement therapy for Vitamin B12; treatment of megaloblastic anemia; pernicious anemia 2) must be given IM every day for 5-10 days than once a month for life 4) itching, rash, signs of excessive B levels (peripheral edema and heart failure)

Hydroxyurea (Droxia) Contraindications Adverse Effects Drug-Drug Interactions

1) severe anemia or leucopenia; impaired liver or renal function; caution with pregnancy and lactation can cause serious effects on fetus or baby 2) cytotoxic, death of cells; GI effects anorexia, nausea, vomiting, stomatitis, diarrhea, or constipation; rash erythema; bone marrow suppression; headaches, dizziness, disorientation, fever, chills, and malaise; increase risk of cancer development 3) uricosuric agents cause an increase risk of uric acid levels

ferrous aspartate

1)agent used for iron deficiency anemia; dietary supplement as iron 2) available for oral administration; 2-3 weeks to see results 3) Contraindications: hemochromatosis; hemolytic anemias; peptic ulcers, colitis, or regional enteritis 4) Adverse Effects: GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation 5) antacids, tetracyclines, cimetidine decrease absorption of the iron drugs; iron is not absorbed if taken with eggs, mild, coffee, or tea, acidic liquids may enhance the absorption

Erythropoiesis stimulating agents Pharmacokinetics 1 Contraindications 2 Adverse Effects 3

1)both (darbepoetin & epoetin) can be given IV or by subcutaneous injection 2)uncontrolled hypertension, lactation; allergy to mammalian cell derived and human albumin 3)Headaches, fatigue, asthenia, dizziness, and seizures; nausea, vomiting, diarrhea; hypertension, edema possible chest pain

Antispasmodics may cause what Nursing Diagnoses?

1. Acute Pain related to GI, CNS, and ophthalmological effects 2. Disturbed Sensory Perception (Visual) related to CNS & Ophthalmological effects 3. Deficient Knowledge regarding drug therapy 4. Risk of Impaired Urinary Elimination related to parasympathetic blocking

A patient in a health care facility has been prescribed trospium for the treatment of an overactive bladder. The physician has instructed the nurse to administer the drug 20 mg orally three times a day. The drug is available in 10 mg tablets. How many tablets will be administered to the patient with each dose?

2 tablets

A patient is receiving oxybutynin transdermally. The nurse would anticipate that the effects of this drug would last for how long?

4 days

The provider ordres Darbepoetin alfa 0.45 mcg/kg for a 210 lb adult. How many micrograms of the drug should be administered?

43 mcg

A 64-year-old patient in hypertensive crisis is to receive furosemide (Lasix) 40 mg IV. Lasix comes in 100 mg/10 mL containers. How will the nurse administer the medication? A) Give 4 mL over 1 to 2 minutes IV. B) Give 4 mL over 10 minutes. C) Flush the line with normal saline, give 1 mL/min, flush again when finished. D) Fix 10 mL in an IV piggyback and deliver it over 30 minutes.

A 68-year-old patient, who has type 1 diabetes, is to receive hydrochlorothiazide (HydroDIURIL). Before administration of this medication, what information is most important for the nurse to communicate to the patient? A) His or her insulin dose may need to be increased. B) His or he insulin dose may need to be decreased. C)He or she will need to have him or her urine checked for ketones four times a day. D) He or she will need to have a creatinine clearance done once a month.

A female patient has a history of frequent bladder infections. Which classification of diuretic would not be recommended for this patient? A) Thiazide and thiazide-like diuretics B) Loop diuretics C) potassium-sparing diuretics D) Osmotic diuretics

A patient has been prescribed furosemide (Lasix). Because this drug causes potassium loss, what will the nurse instruct the patient to eat? A) Peaches B) Apples C) Pears D) Pineapple

A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What would be an appropriate question for the nurse to ask this patient? A) "Are you taking a salicylate?" B) "Are you taking acetaminophen?" C) "Are you taking ibuprofen?" D) "Are you using a lot of salt?"

A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease process. What drug does the nurse suspect that the patient will be prescribed? A) Acetazolamide (Diamox) B) Spironolactone (Aldactone) C) Chlorthalidone (Hygroton) D) Bendroflumethiazide (Naturetin)

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply? A) Potassium losses are lower with spironolactone. B) Potassium losses are greater with spironolactone. C) Water losses are greater with spironolactone. D) Sodium losses are greater with spironolactone.

After teaching a pt who is receiving ferrous sulfate about the drug therapy regimen, which pt statement indicates that the teaching was successful? A) My stools might turn dark or green B) I must take the drug on an empty stomach C) I need to eat three large meals every day D) I need to decrease the amount of fiber I eat

The nurse identifies the pt as having what type of anemia upon learning of the pt's inability to produce intrinsic factor? A) Pernicious anemia B) Sickle cell anemia C) Folic acid deficiency anemia D) Iron deficiency anemia

The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the administration of hydrochlorothiazide (HydroDIURIL)? A) Allergy to sulfa drugs B) Allergy to codeine C) BP 160/96 D) Blood glucose level of 140 mg/dL

The nurse is preparing to discharge a pt with a prescription of Ferumoxytol. What is an important warning for the nurse to share with this pt? A) Avoid magnetic resonance imaging B) Avoid iron-containing foods C) Increase fiber intake if diarrhea occurs D) Do not drink milk until this drug is discontinued

When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), what laboratory value deviations may be related to the medication? A) Elevated uric acid levels B) Reduced blood urea nitrogen (BUN) levels C) A serum potassium level of 4.7 mEq/L D) A hemoglobin A1C of 4.8

Which of the following would the nurse include in the teaching plan when describing anemia to a pt? A) A decreased number of or abnormal RBCs B) A lack of iron in the body C) A lack of vitamin B12 in the body D) An excessive number of platelets

SATA. In a healthy person, very little iron is needed on a daily basis. Loss of iron is associated with which of the following? A) Heavy menstrual flow B) Bileduct obstruction C) Internal bleeding D) Penetrating traumatic injury E) Bone marrow suppression F) Alcoholic cirrhosis

A C D

The nurse is writing a plan of care for an 85-year-old male patient admitted through the emergency room with a severe urinary tract infection. What intervention, if noted on the care plan, would be an inappropriate for this patient?

Administer antacids to decrease GI irritation caused by the medication

Aldosterone levels would be affected if which gland was dysfunctional?

Adrenal *Aldosterone is a hormone produced by the adrenal gland that causes the distal tubule to retain sodium, and therefore water. A dysfunction adrenal gland would result in the insufficient production of aldosterone

A nurse is planning care for a patient who is taking tolterodine. Which of the following is an appropriate nursing diagnosis that is an indication for using this drug? a) Risk for Injury related to multiple drug therapies and drug interactions b) Risk for Deficient Fluid Volume related to the action of the drug c) Risk for Injury related to hyperkalemia secondary to use of the drug d) Altered Urinary Elimination related to overactive bladder

Altered Urinary Elimination related to overactive bladder

Which would lead to a release of aldosterone?

Angiotensin III *Aldosterone is released into the circulation in response to angiotensin III, high potassium levels, or sympathetic stimulation. Aldosterone stimulates a sodium- potassium exchange pump in the cells of the distal tubule, causing reabsorption of sodium in exchange for potassium. As a result of aldosterone stimulation, sodium is reabsorbed into the system and potassium is lost in the filtrate. Natriuretic hormone causes a decrease in sodium reabsorption from the distal tubules with a resultant dilute urine or increased volume. Natriuretic hormone is released in response to fluid overload or hemodilution.

Which stimulates the release of aldosterone from the adrenal gland?

Angiotensin III *Angiotensin II is converted in the adrenal gland to angiotensin III, which stimulates the release of aldosterone from the adrenal gland. The released renin activates angiotensinogen, a substance produced in the liver, which becomes angiotensin I.

The clinic nurse has been assigned to a 43-year-old client who is obese and loves to eat. The client has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which dietary instruction would be a priority for the nurse to discuss with the client? (Ch 47) - Increase intake of fatty acids. - Avoid drinking grapefruit juice. - Decrease intake of plant stanols. - Increase intake of milk and dairy products.

Avoid drinking grapefruit juice. Rationale: HMG-CoA reductase inhibitors block HMG-CoA reductase from completing the synthesis of cholesterol. This blocks the early rate-limiting step in the synthesis of cellular cholesterol that involves the enzyme HMG-CoA. Thus, serum cholesterol and LDL levels decrease because more LDLs are absorbed by the cells for processing into cholesterol. In contrast, HDL levels increase slightly with this alteration in fat metabolism. (pg 821) Patients who are taking HMG-CoA inhibitors need to be cautioned to avoid drinking grapefruit juice while taking these drugs. Grapefruit juice alters the metabolism of the drugs, leading to an increased risk for adverse effects, such as the potentially fatal rhabdomyolysis with renal failure. The metabolism of the components of grapefruit juice takes about 48 hours . Since the effects may last for several days, just drinking grapefruit juice at a different time of the day does not protect the patient from risk. (pg 823, Box 47.7)

The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after administration? A) Weight of patient B) Blood pressure of patient C) Pulse of patient D) Respiratory rate of patient

The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element? A) Calcium B) Potassium C) Glucose D) Magnesium

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient's instructions regarding the use of a diuretic at home include? A) Measuring intake and output of urine B) To weigh themselves on the same scale, at the same time of day, in the same clothing C) Restrict fluids to 500 mL/d to limit the need to urinate D) Decrease exercise to conserve energy

The nurse on the coronary unit is caring for a patient with known coronary artery disease who is being treated with cholestyramine (Questran) and hydrochlorothiazide (HydroDIURIL). What action will the nurse take? A) Call the physician and refuse to give the drugs without further orders. B) Make sure that the drugs are given at least 2 hours apart. C) Give the patient an antacid with the drugs. D) Check the patient's blood glucose level before giving the drugs.

The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics? A) Hyperkalemia B) Alkalosis C) Hypertension D) Hypercalcemia

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act on which site in the nephron? A) Proximal tubule B) Glomerulus C) Ascending limb of loop of Henle D) Collecting tubule

What is the term for the action of a diuretic in a patient with glaucoma? A) Intraocular pressure (IOP) B) Osmotic pull C) Diuresis D) Potassium sparing

SATA. After teaching a pt about the adverse effects of iron therapy, the pt demonstrates understanding of the information by identifying what potential adverse effects? A) Dizziness B) Anorexia C) Dark stools D) Fatigue E) Constipation

B C E

SATA. The nurse is teaching a pt who is to receive epoetin alfa about possible adverse effects. What would the nurse include? A) Dehydration B) Vomiting C) Diarrhea D) Hypotension E) Asthenia

B C E

SATA. Pts are often given iron pills by their clinic. Instructions in giving these pills should include: A) Taking the drug will milk to avoid GI problems B) The potential for constipation C) Keeping these potentially toxic pills away from children D) Taking the drug with antacids to alleviate GI upset E) Having periodic blood tests to evaluate the drug effect F) Being aware that stools may be colored green

B C E F

When providing medication teaching a client prescribed spironolactone, what food should the client be instructed to avoid? (Ch 51) - Fish - Apples - Crackers - Bananas

Bananas Rationale: Patients should be advised to avoid foods that are high in potassium. (pg 902) Potassium-rich foods include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, oranges, peaches, potatoes, prunes, rhubarb, Sanka coffee, spinach, sunflower seeds, tomatoes, and watermelon. (Box 51.6)

Urinary Tract AntiSpasmodics

Blocks parasympathetic activity; thus suppressing over-activity, which leads to relaxation of the detrusor and other urinary tract muscles *Relieve spasms from dysuria (pain or discomfort with urination), urgency, incontinence, nocturia (recurrent nighttime urination), suprapubic pain.*

A pt with anemia who is given iron salts could expect to show a therapeutic increase in hematocrit: A) Within 72 hours B) Within 2 to 3 weeks C) Within 6 to 10 months D) Within 1 to 2 weeks

After teaching a group of students about RBC production the instructor determines that the teaching was effective when the group states that the rate of RBC production is controlled by: A) Iron B) Folic acid C) Erythropoietin D) Vitamin B12

Megaloblastic anemia is a result of insufficient folic acid or vitamin B12, affecting which of the following? A) White blood cell production B) Vegetarions C) Rapidly turning over cells D) Slow-growing cells

The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics? A) Loop diuretics B) Carbonic anhydrous inhibitors C) Thiazide and thiazide-like diuretics D) potassium-sparing diuretics

The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to contact the physician? A) Indomethacin (Indocin) B) Colestipol (Colestid) C) Lithium (Eskalith) D) Ibuprofen (Motrin)

The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic? A) Spironolactone (Aldactone) B) Bumetanide (Bumex) C) Mannitol (Osmitrol) D) Ethacrynic (Edecrin)

The nurse is preparing to administer a pt's first prescribed dose of iron dextran. What education should the nurse provide before administering the medication? A) This pill might make your stool appear dark for the next few days B) This will increase your iron levels during your dialysis session C) Pts often find this injection somewhat painful D) It's important that you take this on an empty stomach

The nurse is providing care for a pt who has been admitted to the hospital with urosepsis and who take hydroxyurea on an ongoing, daily basis. In addition to assessing the course of the pt's infection, the nurse should prioritize what other assessment? A) Cardiac assessment B) Neurologic assessment C) Pain assessment D) Respiratory assessment

What drug would be appropriate for the nurse to administer to treat iron toxicity? A) Succimer B) Calcium disodium edetate C) Deferoxamine mesylate D) Dimercaprol

agents treating megaloblastic anemia contraindication Folic Acid Derivatives

CONTRAINDICATION -allergy CAUTION -P & L -nasal cyanocobalamin should be used with caution in the presence of nasal erosion or ulcers --> alter absorption of drug

Erythropoiesis-Stimulating Agents contraindication and caution

CONTRAINDICATION: -allergy -uncontrolled HRN --> risk of further HTN when RBC increase -lactation-->allergic rx to neonate CAUTION: -pt with normal renal functioning and adequate levels of erythropoietin --> rebound erythropoietin -anemia and normal renal function -> can cause severe anemia

A client is taking atorvastatin to reduce serum cholesterol. Which aspect of client teaching is most important? - Call the health care provider if muscle pain develops. - Eat two eggs per day to increase protein stores. - Decrease the dose if lethargy occurs. - It is acceptable to eat saturated fats.

Call the health care provider if muscle pain develops.

Which electrolyte promotes the movement of sodium out of the cell?

Chloride *Chloride is an important negatively charged ion that helps to maintain electrical neutrality with the movement of cations across the cell membrane. Chloride is primarily reabsorbed in the loop of Henle, where it promotes the movement of sodium out of the cell.

The client is a woman 65 years of age being treated for anemia secondary to chronic kidney disease. The nurse explains to the client that she will be getting a prescription for Epogen. Which of the following additional information would the nurse provide?

Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia.

The nurse is teaching a male client who has just been prescribed a bile acid sequestrate. The nurse teaches the client that he may mix his lipid-lowering agent with a carbonated beverage. What bile acid sequestrant is the client taking? - Cholestyramine (Questrant) - Colesevelam (Colestid) - Colestipol (Colestid) - Ezetimibe (Zetia)

Colestipol (Colestid)

A pt with anemia is prescribed ferrous sulfate. The nurse should recommend what action to relieve the likely adverse effects? A) Avoid high-sodium foods and processed foods B) Take the medication with an antacid C) Take the medication at bedtime D) Increase fluid and fiber intake

After teaching a pt with pernicious anemia about vitamin B12 therapy, which pt statement would indicate that the teaching was successful? A) I can take this pill with breakfast B) I should take this pill at bedtime C) I need to inject this drug subcutaneously every day D) I need to inject this drug IM every 5 to 10 days

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what? A) Carbonic anhydrase inhibitors B) Osmotic diuretics C) Potassium-sparing diuretics D) Thiazide diuretics

The nurse is caring for a pt taking an iron preparation who is admitted to the facility with septicemia. What antibiotic, if ordered by the provider, should the nurse question? A) Gentamicin B) Erythromycin C) Penicillin D) Ciprofloxacin

The nurse is caring for a pt taking ferrous sulfate. What dietary guideline should the nurse recommend to the pt? A) Do not drink grapefruit juice at any time during treatment B) Limit fat intake while taking iron C) Limit sodium intake until iron therapy is complete D) Avoid taking the medication with eggs or dairy

The nurse is talking with a group of nursing students. What drug would the nurse tell them, when combined with furosemide (Lasix), is likely to cause hearing loss? A) Codeine B) Ciprofloxacin (Cipro) C) Digoxin (Lanoxin) D) Gentamicin (Garamycin)

The nurse teaches the parents to administer an iron solution to their child who has anemia. What action should the nurse recommend? A) Have the child take a chewable antacid after taking the medication B) Sip the solution slowly over 30 minutes, if possible C) Mix the solution with chocolate milk to make it more palatable D) Have the child drink the solution with a straw

The nurse would expect the physician to prescribe Epoetin alfa as the drug of choice: A) For acute blood loss during surgery B) To replace blood loss from traumatic injury C) For treatment of anemia during lactation D) For treatment of anemia associated with renal failure

What pt is most likely to benefit from the use of a folic acid supplement? A) A pt with chronic renal failure who is anemic B) A pt who lost a significant amount of blood in workplace accident C) A pt who is on a low-calorie diet to lose weight D) A pt who is attempting to become pregnant

Urinary Tract Anti- Infectives

Destroy bacteria : *through a direct antibiotic effect ; or through acidification of urine* Used to treat *chronic UTIs*, acute cystitis, phylenoephritis; and Anti-Infectives are used to prevent urinary tract anatomical abnormalities and residual urine disorders

Prototype Summary: Mannitol Adverse Effects:

Dizziness, headache, hypotension, rash, nausea, anorexia, dry mouth, thirst, diuresis, fluid and electrolyte imbalances.

Adverse Effects of Hydroxyurea

Dizziness, headache, rash, erythema, anorexia, nausea, vomiting, stomatitis, bone marrow depression, cancer.

Prototype Summary: Hydrochlorothiazide Adverse Effects:

Dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, or spasms.

Prototype Summary: Furosemide Adverse Effects:

Dizziness, vertigo, paresthesias, orthostatic hypotension, rash, urticaria, nausea, anorexia, vomiting, glycosuria, urinary bladder spasm.

A patient with benign prostatic hypertrophy is receiving treatment with finasteride (Proscar). What is an appropriate patient instruction? a) You may donate blood every 3 months. b) Do not let your wife handle the pills. c) Your libido may be increased by this drug. d) Enhance the drug with saw palmetto.

Do not let your wife handle the pills.

A small group of nursing students are giving an oral presentation to their classmates about urinary tract infections (UTIs). What is a measure that can be used to encourage patients to use to reduce the risk of recurrent urinary tract infections?

Drink 2,000 to 3,000 mL of fluid daily.

The nurse is providing health teaching to a patient who is taking Nitrofurantoin. What instruction would be most important to include for the patient?

Drink citrus juice with the medication to acidify the urine.

The nurse would caution the client to avoid driving if which adverse reaction of urinary tract anti-infectives occur? a) Anorexia b) Drowsiness c) Rash d) Photosensitivity

Drowsiness

What are the side effects of Oxybutynin?

Drowsiness, dizziness, blurred vision, tachycardia, dry mouth, nausea, urinary hesitancy, decreased sweating

The nursing instructor is talking with a student about erythropoietin drug therapy. What is an adverse effect of erythropoietin drug therapy that the instructor would tell the student about? - Constipation - Hypotension - Depression - Edema

Edema

A 22-year-old female who has severe dysmenorrhea has been prescribed ferrous gluconate (Fergon) to treat iron deficiency anemia. What is important for the nurse to instruct the client to avoid when taking the drug? - Eggs - Pork - Chocolate - Whole wheat

Eggs

Prototype Summary: Mannitol Actions:

Elevates the osmolarity of the glomerular filtrate, leading to a loss of water, sodium, and chloride; creates an osmotic gradient in the eye, reducing IOP; creates an osmotic effect that decreases swelling after transurethral surgery.

Actions of Ferrous Sulfate (Prototype of Iron Preparations)

Elevates the serum iron concentration and is then converted into hemoglobin or stored for eventual conversion to a usable form of iron.

agents treatingIron deficiency anemia action

Elevates the serum iron concentration and is then converted into hemoglobin or stored for eventual conversion to a usable form of iron.

Drugs for treating Benign Prostatic Hyperplasia

Ensure that prostate enlargement is benign Either relaxes bladder and urinary tract or blocks testosterone production

A client has been diagnosed with chronic renal failure. Which medication will assist in raising the client's hemoglobin levels? - Estazolam - Epoetin alfa - Pentoxifylline - Dextromethorphan

Epoetin alfa

Which substance stimulates the bone marrow to produce red blood cells?

Erythropoietin *Erythropoietin stimulates the bone marrow to produce red blood cells, thereby increasing the amount of hemoglobin available to carry oxygen. The kidneys produce prostaglandin E and prostacyclin, which have vasodilatory effect and are important in maintaining renal blood flow. Renin is involved in controlling arterial blood pressure.

Actions of Hydroxocobalamin (Prototypes of Folic Acid Derivatives or Vitamin B12)

Essential for nucleic acid and protein synthesis; used for growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis.

Actions of Hydroxocobalamin (Vitamin B12)

Essential for nucleic acid and protein synthesis; used for growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis.

In starting a new job as a nurse with a group of renal specialists, the nurse is taught that while the primary function of the urinary system is the transport of urine, the kidneys perform several functions. Which is NOT a function of the kidneys?

Excreting protein *While the kidneys excrete excess water and the nitrogen-based waste products of protein metabolism, persistent renal excretion of protein is not the function of kidneys which are in the state of homeostasis.

True or False: The mature red blood cell contains a nucleus.

False; There is no nucleus in a mature red blood cell

Prototype of Iron Preparations

Ferrous Sulfate

Prototype of agents treatingIron deficiency anemia

Ferrous Sulfate (Feosol)

A patient with benign prostatic hyperplasia has been self-treating with an herbal called saw palmetto. The nurse would know which drug is contraindicated in this patient?

Finasteride

Which drug blocks the production of testosterone?

Finasteride

What two alpha-adrenergic blockers are associated with decreased libido, impotence, and sexual dysfunction?

Finasteride and dutasteride

Prototypes of Folic Acid Derivatives or Vitamin B12

Folic Acid

agents treating megaloblastic anemia Prototypes of Folic Acid Derivatives

Folic Acid

levoleucovorin (Fusilev)

Folic Acid Derivative 1) replacement therapy and treatments of megaloblastic anemia; to diminish the toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdose of folic acid antagonists after high-dose methotrexate therapy in osteosarcoma 2) IV

Leucovorin (generic)

Folic Acid Derivative 1) replacement therapy and treatments of megaloblastic anemia; uses as "leucovorin rescue" after chemotherapy, allowing noncancerous cells to survive the chemotherapy; used with fluorouracil for palliative tx of colorectal cancer 2) oral, IM, IV

Agents for Megaloblastic Anemias

Folic Acid Derivatives (essential for cell growth and division and for the production of a strong stroma in RBCs): - folic acid (generic) - leucovorin (generic) - levoleucovorin (Fusilev) Vitamin B12 (maintenance of the myelin sheath in nerve tissue): - cyanocobalamin (Nascobal) - hydroxocobalamin (generic) 2) considered essential during pregnancy and lactation 4) mild diarrhea, pain and discomfort at injection site

*Pregnant* or *lactating* women with *cystitis* can take *_________________* because it is given in a *single dose*.

Fosfomycin(Monurol)

Patient teaching to help *prevent urinary tract infections* include *teaching young girls* to wipe from *__________* to *__________*.

Front to Back

PROTOTYPE OF LOOP DIURETICS

Furosemide

What is an example of a loop diuretic? (Ch 51) - Furosemide (Lasik) - Chlorothiazide (Diuril) - Acetazolamide (Diamox) - Spironolactone (Aldactone)

Furosemide (Lasik) Rationale: Furosemide is a loop diuretic. Chlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic. (pg 890)

Adverse effects of Phenazopyridine

GI upset, headache, rash, reddish-orrange color of urine, may cause hepatic or renal toxicity

Adverse Effects of Ferrous Sulfate (Prototype of Iron Preparations)

Gastrointestinal upset, anorexia, nausea, vomiting, constipation, diarrhea, central nervous system toxicity progressing to coma and death with overdose.

Which structure acts as an ultra-fine filter for all the blood that flows through it?

Glomerulus

Adverse Effects of Epoetin Alfa (Prototype of Erythropoiesis-Stimulating Agents)

Headache, arthralgias, fatigue, asthenia, dizziness, hypertension, edema, chest pain, nausea, vomiting, diarrhea.

How are thiazides primarily given?

It "pulls" fluid via "osmotic pull"

How does an osmotic diuretic work?

When describing the fluid in the ascending loop of Henle, what would be most accurate?

Hypotonic *The fluid in the ascending loop of Henle is hypotonic in comparison to the hypertonic situation in the peritubular tissues. The filtrate in the descending loop is highly concentrated in comparison to the rest of the filtrate.

A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route?

IV or subcutaneously hematopoietic agent = erythropoiesis-stimulating agent

Peaches, bananas, oranges, raisins (high K+)

If a patient is prescribed furosemide, what foods would s/he be instructed to eat?

A patient is taking phenazopyridine (Azo-Standard) and ciprofloxacin (Cipro) for a urinary tract infection. What is the most important instruction the nurse needs to provide to the patient concerning this drug combination?

If you notice yellowing of your eyes or skin, contact your health care provider immediately.

A nurse is educating a patient undergoing treatment for genitourinary tract bacterial infections on an outpatient basis. What instructions should the nurse offer the patient as part of the patient teaching plan? a) Notify the PHCP if abdominal pain occurs. b) Discontinue the therapy if symptoms vanish. c) Decrease fluid intake if symptoms subside. d) Increase fluid intake to at least 2000 ml/d.

Increase fluid intake to at least 2000 ml/d.

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile to help him sleep at night. The nurse would teach the client about which of the following adverse effects? - Decreased effectiveness of chamomile. - Decreased absorption of warfarin. - Increased risk of hypertension. - Increased risk of bleeding.

Increased risk of bleeding.

A health care provider has prescribed triamterene to a male client with renal disease. The client informs the nurse that he is taking potassium supplements to address some heart problems. The nurse would be alert for: (Ch 51) - Decreased diuretic effects. - Increased risk of hyperkalemia. - Increased risk of arrhythmias. - Increased risk of bleeding.

Increased risk of hyperkalemia. Rationale: Potassium-sparing diuretics are not as powerful as loop diuretics, but they retain potassium instead of wasting it. They cause a loss of sodium while promoting the retention of potassium. The most common adverse effect of these drugs is hyperkalemia. Patients taking these drugs need to be evaluated regularly for signals of increased potassium and informed about the signs and symptoms to watch out for. Patients should be advised to avoid foods that are high in potassium. (Box 51.6) (pg 901-902)

Actions of Hydroxyurea

Increases fetal hemoglobin production in the bone marrow and dilutes the formation of abnormal hemoglobin S.

What is the result of the dysfunctional affect of aldosterone on of the kidneys' distal tubular system?

Ineffective retention of sodium *Aldosterone causes the distal tubule to retain sodium.

Prototype Summary: Acetazolamide Actions:

Inhibits carbonic anhydrase, which decreases aqueous humor formation in the eye, intraocular pressure, and hydrogen secretion by the renal tubules.

Prototype Summary: Furosemide Actions:

Inhibits the reabsorption of sodium and chloride from the distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

The nurse is aware that fosfomycin may be prescribed by the health care provider because of what feature that is unique among the other urinary tract anti-infectives? a) It is given one time only to treat urinary tract infections. b) It is used to treat acute bacterial urinary tract infections. c) Nausea and vomiting are the primary adverse effects. d) It is administered as an oral medication.

It is given one time only to treat urinary tract infections.

What should you teach patients who are on Phenazopyridine (Pyridum) about the Adverse Effects of the drug?

It turns the urine reddish-orange leading or hemorrhage may progress cal doctor if this occurs The following may happen: headaches alopeca GI disturbances

Adverse Effects of Hydroxocobalamin (Prototypes of Folic Acid Derivatives or Vitamin B12)

Itching, transitory exanthema, mild diarrhea, anaphylactic reaction, heart failure, pulmonary edema, hypokalemia, pain at injection site.

Renin and erythropoietin are produced in which structure?

Juxtaglomerular apparatus *A small group of cells, called the juxtaglomerular apparatus, connects the afferent arteriole to the distal convoluted tubule. It is here that renin and erythropoietin are produced.

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered? (Ch 51) - Ethacrynic acid - Spironolactone - Bumetanide - Mannitol

Mannitol Rationale: Ethacrynic acid is a loop diuretic. Spironolactone is a potassium-sparing diuretic. Bumetanide is a loop diuretic. Mannitol is an osmotic diuretic. (pg 890)

After teaching a group of students about the renal system, the instructor determines that the teaching was successful when the students state:

Most fluid that is filtered by the kidneys is returned to the body. *Most of the fluid that is filtered by the kidneys is returned to the body. The kidneys have three protective layers. The renal system consists of the kidneys and structures of the urinary tract: ureters, bladder, and urethra. *The system have four major functions: maintaining the volume and composition of body fluids; regulating vitamin D activation; regulating blood pressure; and regulating red blood cell production.

A client has begun taking cholestyramine. Which are noted as the most common adverse effects? (Ch 47) - Fatigue and mental disorientation - Nausea, flatulence, and constipation - Increased appetite and blood pressure - Hiccups, nasal congestion, and dizziness

Nausea, flatulence, and constipation Rationale: Bile acid sequestrants bind with bile acids in the intestine to form an insoluble complex that is then excreted in the feces. Bile acids contain high levels of cholesterol. As a result, the liver must use cholesterol to make more bile acids. The hepatic intracellular cholesterol level falls, leading to an increased absorption of cholesterol-containing LDL segments from circulation to replenish the cell's cholesterol. The serum levels of cholesterol and LDL decrease as the circulating cholesterol is used to provide the cholesterol that the liver needs to make bile acids. These drugs are used to reduce serum cholesterol in patients with primary hypercholesterolemia (manifested by high cholesterol and high LDLs) as an adjunct to diet and exercise. (pg 814 & 817) Direct GI irritation, including nausea, constipation that may progress to fecal impaction, and aggravation of hemorrhoids, may occur. (pg 817)

Which nursing observation is an appropriate outcome to indicate effective anti-infective therapy for a urinary tract infection? a) Negative urinalysis b) Adequate fluid intake c) Continued urinary urgency d) Absence of skin rash

Negative urinalysis

The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults? a) Offer a variety of fluids to the client every hour. b) Place a pitcher of water at the client's bedside. c) Increase the client's intake of salty foods. d) Ambulate the client every four hours to encourage thirstiness.

Offer a variety of fluids to the client every hour.

What would be an appropriate nursing intervention for a patient on a urinary tract antispasmodic?

Offer hard, sugarless candy

A patient is to receive methenamine. The nurse anticipates administering this drug by which route? a) Subcutaneous b) Intravenous c) Oral d) Intramuscular

Oral

Prototype Summary: Spironolactone Route:

Oral

Prototype Summary: Furosemide Route

Oral, IV, IM

Prototype Summary: Acetazolamide Route

Oral, Sustained-release oral, IV

Which drug is a urinary antispasmodic?

Oxybutin

A physician prescribes a urinary antispasmodic as a transdermal patch. The nurse identifies this as drug as which of the following? a) Flavoxate b) Tolterodine c) Oxybutynin d) Darifenacin

Oxybutynin

Erythropoiesis-Stimulating Agents indication

PROTOTYPE: Treatment of anemia associated with chronic renal failure, related to treatment of HIV infection or to chemotherapy in cancer patients; to reduce the need for allogenic blood transfusions in surgical patients.

Erythropoiesis-Stimulating Agents action

PROTOYPE acts like the natural glycoprotein erythropoietin to stimulate the production or RBCs in bone marrow

The effects of warfarin (Coumadin) are monitored by what laboratory test(s)? (Ch 48) - RBC - aPTT - PT and INR - Platelet count

PT and INR Rationale: Monitor patient response to the drug: increased bleeding time (warfarin PT of 1.5 to 2.5 times the control value or warfarin PT/INR ratio of 2 to 3). (pg 848) PT stands for prothrombin time and is a blood test that measures the amount of time it takes to clot - this can be used to check for bleeding problems. INR stands for international normalized ratio - INR is calculated from a PT result and is used to monitor how well the blood-thinning medication (anticoagulant) warfarin (Coumadin) is working to prevent blood clots. (pg 1086)

Which substance stimulates the reabsorption of calcium in the distal convoluted tubule?

Parathyroid hormone *Parathyroid hormone stimulates the reabsorption of calcium in the distal convoluted tubule to increase serum calcium levels when they are low. Aldosterone is important in adjusting sodium levels. Antidiuretic hormone is important in maintaining fluid balance and is released in response to falling blood volume, sympathetic stimulation, or rising sodium levels. Vitamin D regulates the absorption of calcium from the gastrointestinal tract.

Patients taking *_________________* should be *warned* that it will cause the urine to turn a *reddish-orange* color.

Phenazopyridine

The *short term* UTI pain relief medication called *_________________* can be taken *with an antibiotic*, but should *not* exceed *2 days* during treatment.

Phenazopyridine

Which drug would the nurse identify as turning a patient's urine reddish brown? a) Oxybutynin b) Norfloxacin c) Solifenacin d) Phenazopyridine

Phenazopyridine

What drug is indicated for urinary tract analgesic in children ages 6-12 ?

Phenazopyridine (but teach child that may change urine color)

agents treatingIron deficiency anemia indication

Prevention and treatment of iron deficiency anemia; dietary supplement for iron.

Prototype Summary: Mannitol Indications:

Prevention and treatment of the oliguric phase of renal failure; reduction of intracranial pressure and treatment of cerebral edema; reduction of elevated intraocular pressure (IOP); promotion of urinary excretion of toxic substances; diagnostic use for measurement of glomerular filtration rate; also available as an irrigant in transurethral prostatic resection and other transurethral procedures.

Prototype Summary: Spironolactone Indications:

Primary hyperaldosteronism, adjunctive therapy in the treatment of edema associated with heart failure, nephrotic syndrome, hepatic cirrhosis; treatment of hypokalemia or prevention of hypokalemia in patients at high risk if hypokalemia occurs; essential hypertension.

An instructor is teaching a group of students about appropriate interventions for a patient with cystitis who is receiving norfloxacin. The instructor determines that the students need additional teaching when they identify which intervention as appropriate? a) Providing citrus juices b) Instructing the patient to complete the full course of therapy c) Encouraging increased fluid intake d) Administering the drug with food if the patient experiences GI upset

Providing citrus juices

For which disorder would treatment with an anti-infective be appropriate? a) Urinary spasms b) Benign prostatic hypertrophy c) Overactive bladder d) Pyelonephritis

Pyelonephritis

The clinic nurse is admitting a 39-year-old woman who has come to the clinic complaining of left-sided tenderness, fever, chills, and flank pain. What does the nurse suspect the patient has?

Pylonephritis

reticulocyte

RBC that has lost its nucleus and entered circulation just recently, not yet fully matured

erythrocytes

RBCs, responsible for carrying oxygen to the tissues and removing carbon dioxide; they have no nucleus and live approximately 120 days

Actions of Folic Acid (Prototypes of Folic Acid Derivatives or Vitamin B12)

Reduced form of folic acid, required for nucleoprotein synthesis and maintenance of normal erythropoiesis.

agents treating megaloblastic anemia Actions Folic Acid Derivatives

Reduced form of folic acid, required for nucleoprotein synthesis and maintenance of normal erythropoiesis. folic acid: increase demand in pregnancy or growth

Indications of Hydroxyurea

Reduction of frequency of painful crisis and need for blood transfusions in adult patients with sickle cell anemia.

How does the renal system influence the production of red blood cells?

Regulating the production and secretion of erythropoietin *Red blood cell production is maintained by the renal system's influence on the production and secretion of erythropoietin. While the renal system is associated with all the options, none of the remaining options are associated with red blood cell production.

Urinary Tract Analgesic

Relieves symptoms (burning, urgency, frequency, pain, discomfort) related to urinary tract irritation from infection, trauma, or surgery.

A nurse is caring for a patient with irritation of the lower genitourinary tract. The patient is administered phenazopyridine. Which of the following conditions in patients contraindicates the use of the drug? a) Renal impairment b) Diabetes c) Convulsive disorders d) Cerebral arteriosclerosis

Renal impairment

Which hormone is secreted by the juxtaglomerular apparatus?

Renin *Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

Which is released in response to a decrease in blood flow to the nephron?

Renin *Whenever blood flow or oxygenation to the nephron is decreased (due to hemorrhage, shock, congestive heart failure, or hypotension), renin is released from the juxtaglomerular cells. Calcium is not involved. Renin activates angiotensinogen. After subsequent conversions, angiotensin III ultimately stimulates the release of aldosterone from the adrenal gland.

When describing the mechanism for blood pressure control by the kidneys, which occurs first when oxygenation to the nephron is decreased?

Renin release *When blood flow or oxygenation to the nephron is decreased, renin is released from the juxtaglomerular cells. The renin enters the circulation and activates angiotensinogen that becomes angiotensin I and that is then converted to angiotensin II, which causes vasoconstriction. Angiotensin II is converted to angiotensin III in the adrenal gland. Angiotensin III stimulates the release of aldosterone.

What function does the kidney perform to assist in maintaining acid-base balance within the necessary normal range?

Return bicarbonate to the body's circulation *The kidney performs two major functions to assist in this balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine.

A patient is being treated for benign prostatic hyperplasia (BPH). The patient asks the nurse how the medicine used to treat BPH is supposed to work. The nurse explains that the drug therapy is designed to relieve the symptoms associated with this condition by doing what?

Shrinking the gland and/or relaxing the sphincter of the bladder

The nurse is caring for a patient who is taking a urinary anti-infective. What would the nurse need to assess this patient for?

Signs and symptoms of continuing urinary tract infection (UTI)

Which electrolyte filters through the glomerulus and enters the renal tubule?

Sodium *Sodium is one of the body's major cations (positively charged ions). It filters through the glomerulus and enters the renal tubule; then, it is actively absorbed in the proximal convoluted tubule to the peritubular capillaries.

Prototype of POTASSIUM-SPARING DIURETICS

Spironolactone

Which is an appropriate intervention for a side effect of a urinary antispasmodic medication? a) Suck on ice or hard candy to treat dry mouth. b) Reduce fluid intake to avoid nocturia. c) Take milk of magnesia daily to control constipation. d) Use caffeinated drinks to prevent drowsiness.

Suck on ice or hard candy to treat dry mouth.

The nurse is counseling a client who has been prescribed nitrofurantoin for treatment of a urinary tract infection. What should the nurse teach the client specific to timing of this medication? a) Take it immediately before going to bed. b) Take it two hours after meals. c) Take it with food or milk. d) Take it one hour before meals.

Take it with food or milk.

A 50-year-old man calls the clinic nurse and complains of gastrointestinal upset after taking nitrofurantoin (Furadantin) on an empty stomach. What recommendation should the nurse make?

Take it with or after meals

How do antispasmodic urinary tract medications work?

The block parasympathetic activity which in turn suppress the overactivity and relaxes the detursor and other urinary tract muscles

What is the expected outcome when the glomerular membrane is damaged?

The filtration of fluid from the blood into the kidney's nephron tubule is impaired. *The fenestrated membrane of the glomerulus allows filtration of fluid from the blood into the nephron tubule. None of the remaining options describe the result of a damaged glomerular membrane.

Prototype Summary: Furosemide Indications:

Treatment of edema associated with heart failure, acute pulmonary edema, hypertension.

Indications of Folic Acid (Prototypes of Folic Acid Derivatives or Vitamin B12)

Treatment of megaloblastic anemia due to sprue, nutritional deficiency.

agents treating megaloblastic anemia Indications Folic Acid Derivatives

Treatment of megaloblastic anemia due to sprue, nutritional deficiency.

Indications of Hydroxocobalamin (Prototypes of Folic Acid Derivatives or Vitamin B12)

Treatment of vitamin B12 deficiency; to meet increased vitamin B12 requirements related to disease, pregnancy, or blood loss.

Indications of Hydroxocobalamin (Vitamin B12)

Treatment of vitamin B12 deficiency; to meet increased vitamin B12 requirements related to disease, pregnancy, or blood loss.

True or False. There is a risk of antibody production with the use of epoetin.

True

True or False: Cyanocobalamin is a form vitamin B12 in a nasal formulation.

True

True or False: The component of the red blood cell that is not recycled is bilirubin.

True

True or False: There is a risk of antibody production with the use of epoetin

True

Urinary tract anti-infectives act directly to destroy the bacteria or through acidification of the urine. a) True b) False

True

Phenazopyridine should not be used for longer than?

Two (2) days

What kind of medications are used to treat UTI's?

Urinary tract anti-infectives

The nurse is assessing a patient who is taking oxybutynin (Ditropan). What would be the priority nursing assessment for this patient?

Vision changes

A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be limited because of possible interference with the effect of the drug therapy. Food rich in which vitamin must be taken in limited quantity? - Vitamin A - Vitamin C - Vitamin K - Vitamin D

Vitamin K Rationale: Warfarin causes a decrease in the production of vitamin K-dependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and an extension of clotting times. It is used to maintain a state of anticoagulation in situations in which the patient is susceptible to potentially dangerous clot formation. (pg 842) Tell patient to read food labels. Food, nutritional supplements, and multivitamins that contain vitamin K may impair anticoagulation. Warfarin effect can be neutralized by oral or parenteral vitamin K. (Wolters Kluwer Nursing Drug Handbook app, under warfarin) Injectable vitamin K is used to reverse the effects of warfarin. Vitamin K promotes the liver synthesis of several clotting factors. (pg 846, Box 48.4)

Prototype Summary: Acetazolamide Adverse Effects:

Weakness, fatigue, rash, anorexia, nausea, urinary frequency, renal calculi, bone marrow suppression, weight loss.

frequent bladder infections

What bladder situation is contradicted with thiazide and thiazide like diuretics?

thiazide, thiazide-like, and sulfa allergies

What conditions are contraindicated when taking hydrochlorthiazide?

potassium

What electrolyte should be closely monitored when taking a diuretic?

constipation

What is a common side effect of cholestyramine?

Spironolactone

What is a potassium sparing diuretic used to treat CHF edema?

hypotension due to sudden drop of fluid levels

What is the immediate concern for a pt taking mannitol

alkalosis

What side effect is caused by loop diuretics

loop diuretics

What type of diuretic are bumetanide and ethacrynic?

osmotic

What type of diuretic is mannitol?

Osmotic diuretic

What type of diuretic should be prescribed when pressure is created due to excess fluid?

to avoid loss of Na+

When prescribed furosemide, why should a pt avoid naproxen sodium?

Thiazide-like diuretic

Which classification does Chlorthalidone fall under?

Carbonic Anhydrase

Which diuretic blocks the formation of carbonic acid and bicarbonate in the renal tubes?

Acetazolamide

Which diuretic decreases the secretion of aqueous humor of the eye and is therefore a good choice for treating glaucoma?

the thiazide diuretics (hydroclorothiazide)

Which diuretic interferes with the secretion of uric acid and therefore has a lowering effect?

Furosemide

Which diuretic is associated with the loss of potassium?

Thiazides and thiazide-likes

Which diuretic is the first choice for HTN?

Loop diuretics

Which diuretic works at the ascending loop of henle?

Osmotic

Which diuretic works at the glomerulus?

Thiazide; thiazide-like

Which diuretic works in the distal convoluted tubule?

K+ Sparing

Which diuretic works in the distal tubule and collecting duct?

Potassium sparing diuretics

Which diuretics are mild and act to spare potassium in exchange for the loss of sodium and water?

Thiazide

Which diuretics block the chloride pump resulting in a decrease of Na, K, and minor loss of H20?

Osmotic Diuretics

Which diuretics use hypertonic pull to remove fluid from the intravascular spaces and send it to the renal tubes?

bendroflume...thiazide chloro...thiazide hydrochloro...thiazide hydroflume...thiazide methychlo...thiazide

Which meds are thiazide diuretics?

chlorthalidone indepamide metolazone

Which meds are thiazide-like?

elevated uric acid can cause gout...gout sucks!

Why do providers pay attention to uric acid levels when prescribing a thiazide?

as a diuretic to lower blood pressure and treat edema

Why is hydrochlorthiazide given?

It "spares" K+ which can lead to an abundance of it in the body

Why is spironolactone associated with hyperkalemia?

It can affect the absorption of other meds

Why should cholestyramine be taken at least two hours apart from other meds?

to avoid dehydration and edema rebound

Why should patients keep drinking water while on diuretics?

It is a diuretic- and many diuretics have glucose elevating effects

Why would insulin possibly need to be adjusted for a pt taking hydrochlorothiazide?

spironolactone spares K+

Why would spironolactone be prescribed instead of furosemide?

acetazolamide can cause increased excretion of lithium- adjustment might me needed

Why would the nurse contact the Dr if s/he prescribes acetazolamide to a pt taking lithium?

Which factors would predispose a female child to urinary tract infections? Select all that apply. a) Wiping back to front after using the toilet b) Evidence of recent sexual abuse c) History of congenital bladder conditions d) Taking daily showers instead of a bath e) Wearing cotton underwear

Wiping back to front after using the toilet • Evidence of recent sexual abuse • History of congenital bladder conditions

A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman? a) "You'll likely find that you have scant amounts of blood in your urine for the first few days, but this is not unusual or problematic." b) "You'll probably need to stop taking your hormone replacement therapy when you're taking Detrol." c) "It's good to measure your heart rate before you take your Detrol each day, and withhold it if your heart rate is below 60 beats/minute." d) "You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued."

You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued."

Sickle Cell Anemia (SCA)

a chronic hemolytic anemia that occurs almost exclusively in African Americans; a genetic disorder that causes abnormal hemoglobin, resulting in red blood cells that assume an abnormal sickle shape

megaloblastic anemia

anemia caused by lack of vitamin B12 and/ or folic acid, in which RBCs are fewer in number and have a weak stroma and a short lifespan; treated by replacement of folic acid and vitamin B12

megaloblastic anemia

anemia caused by lack of vitamin B12 and/or folic acid, in which RBCs are fewer in number and have a weak stroma and a short lifespan; treated by replacement of folic acid and vitamin B12

Which substance acts to increase blood pressure by inducing vasoconstriction?

angiotensin II

Erythrocytes

another name for red blood cells; they have no nucleus and live approximately 120 days

Norfloxacin

antibiotic that is *used to specifically treat UTIs caused by susceptible bacteria* ; treats uncomplicated urethral and cervical gonorrhea and prostatitis

Which of these ions plays an important role in pH homeostasis?

bicarbonate *Bicarbonate is an important buffer in body fluids, maintaining pH homeostasis.

When explaining the action of terazosin to a patient, which would the nurse include?

blocks alpha-1 adrenergic receptors

The nurse is describing the need to maintain the acidity of urine based on the understanding that this is necessary to:

destroy any bacteria that may enter. *Urine is usually a slightly acidic fluid; this acidity helps to maintain the normal transport systems and to destroy bacteria that may enter the bladder. The acidity does not play a role in maintaining fluid balance or affect sphincter control. Peristaltic movement is necessary to push urine down from the ureters into the bladder.

Patients using Finasteride or dutrasteride cannot do what for 6 months following the treatment ?

donate blood or father a child

Agents Used for Iron Deficiency Anemia

ferrous aspartate ( FE Aspartate) ferrous fumarate (Feostat) ferrous gluconate (Fergon) ferrous sulfate (Feosol) ferrous sulfate exsiccated (Ferralyn Lanacaps, Slow FE) ferumoxytol (Feraheme) iron dextran (InFed) iron sucrose (Venofer) sodium ferric gluconate complex (Ferrlecit) (can be used during pregnancy & lactation)

Saw palmetto an Herbal therapy for benign prostatic hyperplasia (BPH) should not be combined with what drug that also treats this condition?

finasteride

If a chilled is older than 12 years of age what drug is used as an antispasmodic?

flavoxate

If an antibiotic is needed to treat urinary tract infections during pregnancy one-dose of what medication should be used?

fosfomycin

Name different types of anemia.

iron deficiency anemia, megaloblastic anemia, and hemolytic anemia (sickle cell anemia)

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa?

iron supplement

Darfenacin and fesoterodine should not be combined with antifungals or antivirals because?

it creates toxic effects

A patient has been stung by a bee. The patient's blood pressure drops. Which part of the nephron will release a substance to increase the patient's blood pressure?

juxtaglomerular apparatus

How dos Doxazosin (Cardura) work?

leads to dilation of arterioles and veins (lowers BP) and relaxes sphincter

iron deficiency anemia

low RBC count with low iron available because of high demand, poor diet, or poor absorption; common in menstruating women, pregnant and lactating women, rapidly growing adolescents, persons with GI bleeding; treated with iron replacement therapy

iron deficiency anemia

low RBC count with low iron available because of high demand, poor diet, or poor absorption; treated with iron replacement

hypokalemia

low potassium in the blood, which often occurs after diuretic use; characterized by weakness, muscle cramps, trembling, nausea, vomiting, diarrhea, and cardiac arrhythmias

Which would be most important prior to beginning therapy with a urinary anti-infective agent?

obtaining a urine culture and sensitivity test

The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults?

offer a variety of fluids to the client every hour

Gentamicin (a loop diuretic)

ototoxicity (hearing loss) increases if what type of drug is combined with amnioglycoside antibiotics or cisplatin.

The nurse is caring for a client with a nursing diagnosis of "Impaired urinary elimination related to discomfort of urinary tract infection." Which medication will provide comfort to this client?

phenazopyridine

The nurse is caring for a 79-year-old male patient who was admitted through the emergency room for mental status changes determined to be caused by a urinary tract infection. The patient is started on an anti-infective before his discharge home. What adverse effect should the nurse observe this patient for?

photosensitivity

The outer portion of the kidney is called the

renal cortex

A client with a urinary tract infection (UTI) has a new prescription for nitrofurantoin. The nurse would question this order if the client has a history of:

renal dysfunction

A nurse is caring for a client with irritation of the lower genitourinary tract. The client is administered phenazopyridine. Which condition in clients contraindicates the use of the drug?

renal impairment

A 72-year-old female clinic patient is started on an anti-infective for a urinary tract infection. Before administering this drug, the nurse should assess the patient for what condition?

renal insufficiency

Erythropoiesis-Stimulating Agents pharm

route: IV & SubQ PROTOTYPE: clearing how the body normally clears erythropoetin

A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to:

schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.

Phenazopyridine is contraindicated in presence of?

sever renal dysfunction, pregnancy & lactation, and in those who have had hypersensitive reactions to it

Doxasin can cause?

sexual dysfunction

A nurse is caring for a client who is taking a urinary anti-infectives. The nurse would need to assess this client for:

signs and symptoms of continuing UTI

A client who takes digoxin for heart failure is also prescribed trospium. The nurse would monitor the client closely for:

signs of digoxin toxicity

alkalosis

state of not having enough acid to maintain normal homeostatic processes; seen with loop diuretics, which cause loss of bicarbonate in the urine

Prototype Summary: Hydrochlorothiazide Actions:

stops reabsorption of sodium and chloride in distal renal tubules, increasing the excretion of sodium, chloride, and water by the kidneys.

The only part of the RBC that cannot be recycled is

the toxic pigment bilirubin, which is conjugated in the lived, passed into the bile, and excreted from the body in feces or urine. the building block of the RBC (e.g. iron, vitamin B12) are recycled and returned to the bone marrow for the production of new RBCs

pernicious anemia

type of megaloblastic anemia characterized by lack of vitamin B12 secondary to low production of intrinsic factor by gastric cells; vitamin B12 must be replaced by intramus- cular injection or nasal spray because it cannot be absorbed through the gastrointestinal tract

Pernicious anemia

type of megaloblastic anemia; occurs when the gastrci mucosa cannot produce intrinsic factor and vitamin B 12 cannot be absorbed; lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream; treated with parenteral or nasal vitamin B12; damage to myelin sheath

Which laboratory test should the nurse monitor to evaluate treatment effectiveness, when a client has been prescribed a medication to manage bladder spasms associated with a urinary tract infection?

urine culture and sensitivity

Fin astride should not be touched by whom?

women of childbearing age (it alters reproductive function if touched to skin)

Which adverse effects might be experienced by a patient taking an antispasmodic? Select all that apply. a) Blurred vision b) Dizziness c) Diarrhea d) Bradycardia e) Vomiting

• Blurred vision • Vomiting • Dizziness

Which of the following drugs can be used to treat dysuria caused by a UTI? Select all that apply: a) Oxybutynin (Ditropan) b) Nitrofurantoin (Macrodantin) c) Phenazopyridine (Pyridium) d) Flavoxate (Urispas) e) Sulfamethoxazole/trimethoprim (Bactrim)

• Flavoxate (Urispas) • Phenazopyridine (Pyridium)

A patient with overactive bladder symptoms was given a new prescription for an antispasmodic. With which medications does this medication category interact? Select all that apply. a) Promethazine (Phenergan) b) Acyclovir (Zovirax) c) Metformin (Glucophage) d) Docusate (Colace) e) Haloperidol (Haldol)

• Haloperidol (Haldol) • Promethazine (Phenergan) • Acyclovir (Zovirax)

Prior to administering oxybutynin (Ditropan) to a client, the nurse should get a full medical history because the use of oxybutynin (Ditropan) is contraindicated in clients with which of the following? Select all that apply: a) Myasthenia gravis b) Hypertriglyceridemia c) Diabetes d) Intestinal blockage e) Urinary tract blockage

• Myasthenia gravis • Urinary tract blockage • Intestinal blockage

Fosfomycin (Monurol) is an anti-infective that when administered orally is found in high concentrations in the urine, which makes it ideal for treating which of the following infections? Select all that apply: a) Pyelonephritis b) Hepatitis c) Prostatitis d) Encephalitis e) Cystitis

• Pyelonephritis • Prostatitis • Cystitis

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