Pharmacology Exit HESI Verified Questions and Answers

Nurse should observe most closely for drug toxicity when a client receives med that has what characteristic

Narrow therapeutic index

The nurse should observe most closely for drug toxicity when a client receives a medication that has which characteristic?

o   Low bioavailability

o   Rapid onset of action

o   Short half life

o   Narrow therapeutic index. 

o   Rationale: A drug with a narrow therapeutic index has a high risk for toxicity because there is a narrow range between the therapeutic dose and the toxic dose.

·         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

A client with hyperthyroidism is receiving propranolol (Inderal). Which finding indicates that the medication is having the desired effect?

·         Decrease in serum T4 levels

·         Increase in blood pressure

·         Decrease in pulse rate

·         Goiter no longer palpable

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

-          A client experiencing withdrawal from the benzodiazepines alprazolam (Xanax) is demonstrating severe agitation and tremors. What is the best initial nursing action?

1.    Administer naloxone (Narcan) per PNR protocol

2.    Initiate seizure precautions

3.    Obtain a serum drug screen

4.    Instruct the family about withdrawal symptoms.

·         Rationale: Withdrawal of CNS depressants, such as Xanax, results in rebound over-excitation of the CNS. Since the client exhibiting tremors, the nurse should anticipate seizure activity and protect the client.

Patient Dx with bipolar-how to know if meds are effective

Family states patient is doing better with manic phases

-         A client with bipolar disorder began taking valproic acid (Depakote) 250 mg PO three times daily two months ago. Which finding provides the best indication that the medication regimen is effective?
•The family reports a great reduction in client’s maniac behavior

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

-          Someone's on digoxin and Lasix how do you know the meds are working; is it because potassium is at 4,  magnesium or something else 

Tamoxifen Citrate use and therapeutic outcome

-         Breast cancer

Fosomax for osteoarthritis patient teaching

1.    A female client receives a prescription for alendronate sodium (Fosamax) to treat her newly diagnose osteoporosis. W /hat instruction should the nurse include in the client’s teaching plan?

·         Take on an empty stomach with a full glass of water

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

-    A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level?
A) Sixty minutes after the antibiotic dose is administered.
B) Immediately before the next antibiotic dose is given.
C) When the next blood glucose level is to be checked.
D) Thirty minutes before the next antibiotic dose is given.

-     Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given (B). (A, C, and D) do not describe the optimum time for obtaining a trough level of an antibiotic.

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: .5-1.5 hours

Short acting- regular (humulin) Onset: 30-60 minutes Peak: 2-3 hours (IV ok)

Intermediate acting- NPH Onset: 1-2 hours Peak 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

-          A nurse is administering a drug that is categorized as Schedule IV. The nurse understands that this means the drug:
A. Has acceptable medical applications with low potential for abuse
B. Is a controlled sub with no accepted medical use
C. Is dangerous to admin to pregnant or breast-feeding pts
D. Has the potential for serious and life-threatening adverse effects

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

-          When teaching a patient who has a gastric ulcer about cimetidine (a histamine H2 antagonist) therapy, the nurse should include which information about antagonists
A. An antagonist causes a chemical reaction in the stomach
B. An antagonist activates receptors in the stomach lining
C. An antagonist prevents receptor activation in the stomach
D. An antagonist improves receptor sensitivity in the stomach

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

-          The nurse cares for a patient taking a calcium channel blocker for hypertension. The nurse is most concerned if the patient makes which statement?

                        "I drink a glass of grapefruit juice each evening"

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

-          A patient with mild symptoms of Alzheimer's disease is prescribed donepezil (Aricept). Which statement made by the patient indicates a need for further teaching?

-          "The drug will stop damage to the neurons in my brain."

**Donepezil will improve transmission by neurons in the brain because more acetylcholine will be availalble (it is a cholinesterase inhibitor), it may cause an upset stomach, and it is a good idea to take it at bed time because of the side effects. It will not, however, stop the damage in the brain, it only provides symptom control.**

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

-          A patient with schizophrenia is prescribed chlorpromazine (Thorazine) oral concentrate. Which of the following discharge instructions should the nurse complete?
A. Sexual arousal may be enhanced with this medication.
B. Avoid direct skin contact with the medication.
C. The medication may cause excessive salivation.
D. Do not limit salt intake while taking the medication.