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?
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?
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?
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
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.
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