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Pharmacology Exit HESI Nurse should observe most closely for drug toxicity when a client receives med that has what characteristic Narrow therapeutic index Nurse is conducting DC teaching about anti-anxiety drug dia ...

Pharmacology Exit HESI Nurse should observe most closely for drug toxicity when a client receives med that has what characteristic Narrow therapeutic index Nurse is conducting DC teaching about anti-anxiety drug diazepam (valium) Evaluate the ingredients of all over-the-counter drugs for alcohol content Nursing instruction most important for patient on Zyloprim Increase fluid intake Client getting Tofranil (Imipramine) Give medication at night Magnesium antidote Calcium gluconate Patient with hyperthyroidism taking inderal (propanalol) Decreases pulse rate Medication dosing-heparin 25000 units at 7ml/hr doctor changed rate to 900 units what is the Mls/hr Med was ordered 100mg in 4 divided doses in 24 hours available in 25mg, how many will you give every 6 hours 1 Patient on benzos Answer is not narcan Patient Dx with bipolar-how to know if meds are effective Family states patient is doing better with manic phases Patient on Heparin going for surgery in a.m.,-priority Assess patient for bleeds Best time to give patient Abx (I think) Time was like 1000, 1400, 1200, and 0400…best to give around the clock Medication calculation-patient weighs equal to 16kg-order for Tamiflu 45mg BID Must round up-answer is 3.8ml Peptic ulcer med-what action Histamine 2 agonist Patient on folliculitis medication-what to teach Drink with full glass of water Vasopressin Vasoconstrictor Know why Digoxin and Lasix are used together Tamoxifen Citrate use and therapeutic outcome Fosomax for osteoarthritis patient teaching Rifampin for TB Rusty-orange/red colored urine and body fluids Pyridium for bladder infection Orange/red/pink urine Stay in bed for 3 hours post first Ace Inhibitor dose Avoid grapefruit juice with CCB Lipitor (statins) in PM only-no grapefruit juice Trough draw 30 minutes before scheduled dose Peak draw 30-60 minutes after administration Potassium sparing diuretic need to watch for hyperkalemia Aldactone (spirinolactone) Using bronchodilators before steroids for asthma teaching Exhale completely, inhale deeply, hold breath for 10 seconds Insulin can be kept at room temp 28 days Drawing insulin Clear (regular) first then cloudy (NPH) Know the insulins and their peak/onset (there are several Qs about this in different formats) Rapid-Lispro (Humalog) and Aspart (Novolog) Onset: 5-15 minutes Peak: .75-1.5 hours Short acting- regular (humulin) Onset: 30-60 minutes Peak: 2-3 hours (IV ok) Intermediate acting- NPH Onset: 1-2 hours Pea:k 6-12 hours Long acting- Glargine (lantus) Onset: 1.1 hour Peak: 14-20 hours (DO NOT MIX) Chlamidia Tetracycline Trichomoniasis Flagyl Candidiasis Nystatin Herpes Simplex 2 Acyclovir Parkinson’s disease Levodopa/Carbidopa Phenobarbitol Seizures Preparing to administer a drug to a pt with an infection The drug will destroy the microorganism RN is teaching a pt about a new drug… what’s most important to teach the pt to improve the intensity of the response to the drug Take the prescribed dose A nurse is giving morphine 2 mg IV to a pt after surgery and she has followed the “six rights of administration”… Know the possible reactions to morphine RN doesn’t understand why a pt is to receive a prescribed med Verity the reason with the prescribing healthcare provider for use Administration of schedule IV drug, the RN understands The drug has acceptable medical application with low potential for abuse Where would a RN direct a pt to obtain more info about prescribed medications A pharmacist RN is prepared to administer Epinephrine to pt that has a severe allergic reaction IV – no first pass effect Digoxin has 36-48 hr half life – because of the length of half life, the RN expects to be dosing this medication Once a day Pt is prescribed Cimetidine (histamine 2 antagonist) to treat gastric ulcer Inhibit the action of histamine at receptor sites and block gastric acid secretion Drug X has a therapeutic index of 10 and drug Y has an index of 2 Drug Y – more potent A pt taking Digoxin is also prescribed Propanolol. The 2 drugs combined may cause a serious decrease in HR An increased adverse effect A pt prescribed CCB Diltiazem to treat hypertension Grapefruit juice Which of the pts would be at highest risk for an adverse reaction An 84 yo with diabetes, HF, hypertension and takes 8 medications per day RN receives a handwritten medication order – can’t read Contact prescriber to clarify order A breast-feeding pt is prescribed an antimicrobial medication Take immediately after breast-feeding The RN is evaluating the kidney fx of an 82 yo pt before administration of medications – Creatinine clearance – a measure of how the kidneys are fx by excreting creatinine. (BUN – good indicator of volume and dehydration) (Creatinine – is reflective very much by your BUN or level of hydration) The most important factor in an adverse drug reaction in the elderly population is Declining renal fx A pt is prescribed Bethanocol (Muscarinic Agonist) for urinary retention – if pt exhibits signs of overdose such as: increased salivation, sweating, bradycardia, hypotention, the RN would administer Atropine (anticholenergic – makes us dry) The pt takes Oxybutinin (anticholenergic) for OOB takes an OTC antihistamine (anticholenergic) for hay fever Dry mouth, increased temp, and blurry vision (myosis) After IM injection of penicillin the pt develops severe difficulty breathing and swollen tongue (Anaphylaxis) Administer epinephrine A pt receives Dopamine for shock (hypotention, vascular collapse, comatose) Mean arterial pressure Pt receives a drug that blocks adrenergic receptors Orthostatic hypotension (no BP to the brain) Reflex tachacardia is caused by hypotention A pt with diabetes gets a beta blocker (mask the signs of hypoglycemia and blocks beta receptors – inhibits glycogenolysis) Atenolol (more selective) A pt with depression is prescribed an antidepressant – the medication will reach full therapeutic effect 2 to 3 weeks (more like 1 to 2 months but this is the best response) A pt taking Levadopa/Carbadopa (dopaminergic) and experiences a frequent “on – off” episodes Avoid high protein meals – competes with drug A pt is prescribed a Dopamine agonist (Mirapex) (adrenergic agonist) for Parkinson’s “This med will stop the progression of Parkinson’s.” – can’t cure Parkinson’s Pt with mild symptoms of Alzheimer’s is prescribed Donepezil (Aricept) The drug will stop the damage to the neurons in my brain Pt is concerned about developing Alzheimer’s disease Naproxen (NSAID’s) Which assessment best determines the effectiveness of Sumatriptan (triptans are used for treatment of Migraines so… Termination of the migraine Pt with schizophrenia is prescribed chlorpromazine (Thorazine – first generation antipsychotic) oral concentrate The medication may cause excessive salivation And No direct skin contact (both correct – not a good question) Which best assessment best determines the pt is developing tardive dyskinesia Twisting, writhing, worm-like movements of tongue Pt with depression is proscribed Fluoxitine (Prozac) “It may take 3-4 weeks before my mood is elevated” Pt is on Marplan (MAOIs – have the most food interactions) for depression Bananas, smoked fish, and cheese Pt on Lithium Polydypsia (increased thirst), slurred speech, and fine hand tremors Pt is prescribed Lunesta for insomnia Anterograde amnesia (memory loss of events right before taking drug) A 24 yo female gets Triazolam (Halcion) for insomnia at home (remember to use the process of elimination) “The medication will not alter my breathing” A pt is prescribed Venlafaxine and the pt asks what the purpose of medication is, you should state Depression and anxiety A pt with OCD is prescribed Zoloft – which is not a true statement about the medication “I will get better in 3 weeks.” (full effect in 1 – 2 months, you won’t get “better” necessarily) An RN is teaching a parent about administration of aderol to treat their child’s ADD Give the dose in the morning b4 school. (amphetamine – child needs it to concentrate) Amphetamines can cause growth suppression in children Provide snack or meal b4 giving med (because amphetamines suppresses appetite) Pt states that he’s on Oxycodone and the dose that he currently receives does not provide the same pain relief Tolerance A pt with HF is getting Furosemide (Lasix) (loop diuretic is K+ wasting) Oranges, spinach, and potatoes high in potassium A client in renal failure asks why he is being given antacids Calcium and aluminum antacids bind phosphates and help to keep phosphates from being absorbed into blood stream thereby preventing rising phosphate levels, and must be taken with meals Receiving Digoxin for the onset supraventricular tachycardia (SVT) hypokalemnia Receiving Albuterol (Proventil) tablets complains of nausea every evening with her 9pm doseadminister the dose with a snack The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room The clients’ respiratory rate is 16 breaths/min A client who has been taking levadopa PO Tid to control the symptoms of Parkinson’s disease has a new prescription for sustained-release levadopa/carbidopa (Simemet 25/100) PO Bid and took his levadopa at 0800 “You can begin taking the Sinemet this evening, but do not take any more levadopa” Which action is most important for the nurse to implement during the administration of the antirrhythmic drug adenosine (Adenocard) Apply continuous cardiac monitoring Nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects Constipation Which dosing schedule should the nurse teach the client to observe for a controlled release oxycodone Rx q12h The healthcare provider prescribes digitalis (Digoxin) for a client Dx with congestive heart failure Assess the serum potassium level Which method of medication administration provides the client with the greatest first pass effect Oral Most important when caring for a client receiving the antimetabolite cytosine arabinoside (ARC-C) for chemotherapy Inspect the clients’ oral mucosa for ulcerations Identify as being at high risk for complications during the use of an opioid analgesic A young adult with inflammatory bowel Dz Rheumatoid arthritis takes ibuprophin (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed Use contraception during intercourse Receiving methylprednisolone (Solu-Medrol) 40 mg IV daily anticipates an increase in which lab value Serum glucose Parkinson’s Dz and is taking carbidopa-levodopa (Sinemet) indicate that the desired outcome of the medication is being achieved Lessening of tremors Preparing the 0900 dose of losartan (Cozaar) an angiotension-II receptor blocker (ARB) for a client with hypertension and heart failure Withhold the scheduled dose Taking hydromorphone (Dilaudid) PO q4h at home. Following surgery Dilaudid IV q4h PRN and but butorphanol tartrate (Stadol) IV q4h PRN. The pt received a dose of the drug 4 hours ago and is again requesting pain medication Administer only the Dilaudid q4h PRN for pain Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for which condition Heart failure Giardiasis is taking metronidazole (Flagyl) 2 grams PO Take the medication with food The nitrate isosorbide denitrate (Isordil) is prescribed for a client with angina Do not get up quickly, always rise slowly Reviewing the use of the patient controlled analgesics (PCA) pump with a client in the immediate postoperative period The client will receive Morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour The rate and depth of the clients’ respirations A peak and trough level must be drawn for a client receiving antibiotic therapy Immediately before the next antibiotic dose is given When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body Abdomen A client has myxedema which results from a deficiency of thyroid hormone synthesis in adults Pentobarbital sodium Nembutal Sodium for sleep Receiving ampicillin sodium (Omnipen) for a sinus infection Rash A client is being treated for osteoporosis with alendronate (Fosamax) and the nurse has completed discharge teaching regarding medication administration Take medication, go for a 30 minute morning walk, then eat breakfast Continuous IV infusion of dopamine (Intiropin) and an IV of normal saline at 50 ml/hr the nurse notes that the clients urinary output has been 20 ml/hr for the last 2 hours Notify the healthcare provider of the urinary output Which change in data indicates to the nurse that the desired effect of the angiotension II receptor antagonist valsartan (Diovan) has been achieved Blood pressure reduced from 160/90 to 130/80 A healthcare provider prescribes cephalexin monohydrate (Keflex) for a postoperative infection Penicillins Prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise Apply the patch at least 4 hrs prior to departure Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis Bismuth subsalicylate (Pepto Bismol) Prescriptions for morphine sulphate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h administer both medications according to the prescription Hyperlipidemia receives a prescription for niacin (Niaspan) Expected duration of flushing Which drug is used as a palliative treatment for a client with tumor- induced spinal cord compression Dexamethasone (Decadron) Admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications In which order Albuterol (Proventil) puffs Salmeterol (Serevent Diskus) Prednisone (Deltasone) orally Gentamicin (Garamycinim) IM 43-year-old female receiving thyroid replacement hormone following a thyroidectomy Tachycardia and chest pain Receiving clonidine (Catapres) 0.1 mg q24h via transdermal patch Blood pressure changed from 180/120 to 140/70 Which nursing Dx is important to include in the plan of care for a client receiving the angiotension II receptor antagonist irbesartan (Avapro) Risk for injury Osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa Notify the healthcare provider In evaluating the effects of lactulose (Cefulac) Two or three soft stools per day Patient with dysrhythmia is to receive procainamide (Pronestyl) in a 4 divided dose over the next 24 hours Q6h The nurse is transcribing a new prescription for spironolactone (Adactone) for pt who receives an angiotension-converting enzyme (ACE) inhibitor Verify both prescriptions with the healthcare provider Admitted to the coronary care unit with a medical Dx of acute myocardial infarction Nitroglycerin After abdominal surgery prescribed low molecular weight heparin (LMWH) This medication is a blood thinner given to prevent blood clot formation An antacid, (Maalox) is prescribed for a client with peptic ulcer Dz Maintain a gastric pH of 3.5 or above Pt states “I am allergic to penicillin” Cephalosporins A category X drug is prescribed for a young adult female client Use a reliable form of birth control Admitted to the hospital for Dx testing for possible myasthenia gravis prepares for IV administration of edrophonium chloride (Tensilon) Decreases muscle weakness Which symptoms are serious adverse affects of Beta-adrenergic blockers such as propranolol (Inderal) Wheezing, hypotension and AV block Prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs Make an appointment to see the healthcare provider because muscle pain may be a serious side effect The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands Another type of non- steroidal anti-inflammatory drug may be indicated Dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol) Coronary artery Dz. is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor) Vomiting A client is being treated for hyperthyroidism with propylthiouracil (PTU) Inhibit synthesis of T3 and T4 by the thyroid gland Following sublingual nitroglycerin to a pt experiencing an acute anginal attack Client states chest pain is relieved Spironolactone (Aldactone) for heart failure is Rx Refrain from eating foods high in potassium Medication described as a Beta1 agonist is most commonly prescribed for a client with which condition Heart failure Assessing a client that is experiencing anaphylaxis from an insect sting Epinephrine Instruction to give to a female who just received a Rx for oral metronidazoleI(Flagyl) for treatment of trichomonas vaginalis Increase fluid intake, especially cranberry juice Avoid drinking alcohol while taking this medication Use condoms until Tx is completed Ensure that all sexual partners are Tx at the same time Receiving doxorubicin (Adriamycin) IV complains of pain at the insertion site and the nurse notes edema at the site D/C IV fluids Assessing the effectiveness of high dose aspirin therapy for an 88-year- old client with arthritis Notify the healthcare provider of this finding immediately Pt asks the nurse if glipizide (Glucotrol) is oral insulin No, it is not oral insulin and can be used only when some Beta cell function is present Which medication should the nurse caution the client about taking while receiving an opioid analgesic Benzodiazepines Postoperative and has been receiving a continuous IV infusion of mepreidine (Demerol) 35 mg per hr for 4 days and has a PRN Rx for Demerol for 100 mg PO q3h Decrease the IV infusion rate of the mepreidine (Demerol) per protocol Congestive heart failure (CHF) is being discharged with a new Rx for the angiotension-converting enzyme (ACE) inhibitor captopril (Capoten) Dizziness Heparin Tx for a pulmonary embolism a client is being discharged with a Rx for warfarin (Coumadin) Prothrombin Time (PT/INR) Receiving metoprolol (Lopressor SR) Blood pressure Teaching for liver transplant about cyclosporine (Sandimmune) the nurse should encourage the pt to report which adverse response Presence of hand tremors Older client with a decreased percentage of lean body receives a Rx that is adjusted based on which pharmacokinetic process? 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