Chapters 29, 41, 42,43 Flashcards Preview

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Flashcards in Chapters 29, 41, 42,43 Deck (78):

What is the goal of fluid replacement

Blood pressure and blood volume can be maintained


Mimics ECF (blood stream) to quickly restore fluid levels



Stay in bloodstream



Pulls fluid from cell into blood. Makes cell shrink.



Brings fluid into the cell.



When reviewing the health history of a patient, the nurse will note that a potential contraindication to potassium supplements exists if the patient has which problem?
a. Burns
b. Diarrhea
c. Renal disease
d. Cardiac tachydysrhythmias



Stay in bloodstream used for dehydration

NS (normal saline) 0.9%


NS with chloride, Ca, K+, and lactate (buffer to assist in acidosis)

Lactated ringers


During a blood transfusion, the patient begins to have chills and back pain. What is the nurse's priority action?
a. Observe for other symptoms.
b. Slow the infusion rate of the blood.
c. Discontinue the infusion immediately, and notify the prescriber.
d. Tell the patient that these symptoms are a normal reaction to the blood product.



What are the hypotonic solutions used?

NS .45%
D5W (infused glucose is metabolized and solution turns to water)


When the cell presents with the same concentration on the inside and outside with no shifting of fluids this is called?



Hypertonic solutions used?

3% NS
D5 NS (glucose is usually hypertonic)


A patient with cerebral edema would most likely be order what type of solution?

3% Saline


The nurse is working with a graduate nurse to prepare an intravenous dose of potassium. Which statement by the graduate nurse reflects a need for further teaching?
a. "We will need to monitor this infusion closely."
b. "The infusion rate should not go over 10 mEq/hr."
c. "The intravenous potassium will be diluted before we give it."
d. "The intravenous potassium dose will be given undiluted."



Causes fluid to stay in the blood stream



Classified as blood product and colloid. Administered to restore plasma volume. Cause fluid to shift from cells to plasma. Administered to patients with low albumin levels.

Normal Serum Albumin


Normal plasma albumin levels



A patient is in an urgent care center and is receiving treatment for mild hyponatremia after spending several hours doing gardening work in the heat of the day. The nurse expects that which drug therapy will be used to treat this condition?
a. Oral supplementation of fluids
b. Intravenous bolus of lactated Ringer's solution
c. Normal saline infusion, administered slowly
d. Oral administration of sodium chloride tablets



When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign?
a. Seizures
b. Cardiac dysrhythmias
c. Diarrhea
d. Muscle weakness



During an infusion of albumin, the nurse monitors the patient closely for the development of which adverse effect?
a. Hypernatremia
b. Fluid volume deficit
c. Fluid volume overload
d. Transfusion reaction



A patient is receiving an infusion of fresh frozen plasma. Based on this order, the nurse interprets that this patient has which condition?
a. Hypovolemic shock
b. Anemia
c. Coagulation disorder
d. Previous transfusion reaction



The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which intravenous solution is correct for use with the PRBC transfusion?
a. 5% dextrose in water (D5W)
b. 0.9% sodium chloride (NS)
c. 5% dextrose in 0.45% sodium chloride (D5NS)
d. 5% dextrose in lactated Ringer's solution (D5LR)



The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which patient would be best treated with this transfusion?
a. A patient with a coagulation disorder
b. A patient with severe anemia
c. A patient who has lost a massive amount of blood after an accident
d. A patient who has a clotting-factor deficiency



Adverse effects from normal serum albumin

fever, chills, urticaria, rash, dyspnea, and possibly hypotension


Early and late symptoms of hypokalemia

early: hypotension, lethargy
late: cardiac conduction abnormalities


Flagged drug. careful administration is necessary. Can be given oral or by infusion. Needs to be diluted before administration

Potassium chloride (KCl)


What may be given for hyperkalemia? It is an exchange between sodium and potassium, getting rid of K+

Sodium polystyrene sulfonate (Kayexalate)


Jon has a potassium level of 6.5 which medication would nurse Wilma anticipate?



After a severe auto accident, a patient has been taken to the trauma unit and has an estimated blood loss of more than 30% of his blood volume. The nurse prepares to administer which product?
a. Albumin
b. Whole blood
c. Packed red blood cells
d. Fresh frozen plasma



A patient who is severely anemic also has acute heart failure with severe edema due to fluid overload. The prescriber wants to raise the patient's hemoglobin and hematocrit levels. The nurse anticipates that the patient will receive which blood product?
a. Fresh frozen plasma
b. Albumin
c. Packed red blood cells (PRBCs)
d. Whole blood



The nurse is preparing to give a potassium supplement. Which laboratory test should be checked before the patient receives a dose of potassium?
a. Complete blood count
b. Serum potassium level
c. Serum sodium level
d. Liver function studies



During diuretic therapy, the nurse monitors the fluid and electrolyte status of the patient. Which assessment findings are symptoms of hyponatremia? (Select all that apply.)
a. Red, flushed skin
b. Lethargy
c. Decreased urination
d. Hypotension
e. Stomach cramps
f. Elevated temperature



Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells?

Flush the IV line with normal saline before the blood is added to the infusion.


Symptoms of hyponatremia

lethargy, hypotension, diarrhea


Originally called consumption because of ability to waste the body away

Mycobacterial infections


Covers cell surface making bacteria hard to penetrate.

Mycolic acid


An atypical infection that is considered opportunistic as many times is acquired by those with poor immune systems



Active TB signs and symptoms

pneumonia like symptoms, fever, night sweats, fatigue, weight loss and anorexia


The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber?
a. Gastrointestinal upset
b. Headache and nervousness
c. Reddish-orange urine and stool
d. Numbness and tingling of extremities



What meds are given in the initial phase of TB

2 months daily therapy: Isoniazid, rifampin, pyrazinamide (PZA), ethambutol (usually first)


A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition?
a. Hair loss
b. Renal failure
c. Peripheral neuropathy
d. Heart failure



A client is diagnosed with active TB and started on antibiotic therapy. What signs and symptoms would the client show if therapy is inadequate.

Positive acid-fast bacilli in a sputum sample after 3 months of treatment


Most common cause of treatment failure in patients with TB is......

non-compliance with drug therapy


The nurse will assess the patient for which potential contraindication to antitubercular therapy?
a. Glaucoma
b. Anemia
c. Heart failure
d. Hepatic impairment



When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity?
a. Rifampin (Rifadin)
b. Isoniazid (INH)
c. Ethambutol (Myambutol)
d. Streptomycin



The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient?
a. Women have a high risk for thrombophlebitis while on this drug.
b. A higher dose of rifampin will be necessary because of the contraceptive.
c. Oral contraceptives are less effective while the patient is taking rifampin.
d. The incidence of adverse effects is greater if the two drugs are taken together.



The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?
a. Pyridoxine (vitamin B6)
b. Penicillins
c. Phenytoin (Dilantin)
d. Benzodiazepines

C. Dilantin (can cause seizures)


A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct?
a. "Drug therapy will last until the symptoms have stopped."
b. "Drug therapy will continue until the tuberculosis develops resistance."
c. "You should expect to take these drugs for as long as 24 months."
d. "You will be on this drug therapy for the rest of your life."



The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct?
a. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis."
b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant."
c. "Using more than one drug can help to reduce side effects."
d. "Using multiple drugs enhances the effect of each drug."



What is the hardest fungal infection to treat

Systemic=internal organs


During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first?
a. Discontinue the infusion immediately.
b. Reduce the infusion rate gradually until the adverse effects subside.
c. Administer the medication by rapid IV infusion to reduce these effects.
d. Nothing; these are expected side effects of this medication.



What medication is given for systemic ant-fungals

Amphotericin B (Fungizone)


Normal levels of
a. creatinine
b. BUN

a. 0.5-1.2
b. 8-21


The nurse recognizes that pretreatment with pain medication or anti-emetics prior to the administration of amphotericin B is for what effect?

They reduce the severity of adverse effects associated with amphotericin b


The nurse is assessing a patient who is about to receive antifungal drug therapy. Which condition, if found in the patient, would be of most concern?
a. Diabetes mellitus
b. Liver disease
c. Pulmonary disease
d. Bleeding disorders



If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction?
a. Reduced action of oral anticoagulants, resulting in decreased prothrombin time/international normalized ratio (PT/INR)
b. Increased effects of oral anticoagulants, resulting in increased PT/INR
c. Increased change in renal impairment caused by the antifungal drug
d. Decreased effectiveness of the antifungal drug



The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?
a. Discontinuing the infusion immediately if fever, chills, or nausea occur
b. Gradually increasing the infusion rate until the expected adverse effects occur
c. If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms
d. Before beginning the infusion, administering an antipyretic and an antiemetic drug



The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember?
a. The lipid formulations may be given in oral form.
b. The doses are much lower than the doses of the older drugs.
c. The lipid formulations are associated with fewer adverse effects than the older drugs.
d. There is no difference in cost between the newer and older forms.



The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs?
a. "The medication can be stopped when your symptoms are relieved."
b. "Discontinue this medication if menstruation begins."
c. "Daily douching is part of the treatment for vaginal fungal infections."
d. "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved."



A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?
a. fluconazole (Diflucan)
b. micafungin (Mycamine)
c. caspofungin (Cancidas)
d. nystatin (Mycostatin)



A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted?
a. Decreased breath sounds in the lower lobes
b. History of cardiac dysrhythmias
c. History of diabetes type II
d. Potassium level of 4.0 mEq/L



During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result?
a. Serum potassium level of 2.7 mEq/L
b. Serum potassium level of 5.8 mEq/L
c. White blood cell count of 7000 cells/mm3
d. Platelet count of 300,000 per microliter



A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, "I don't want to do this for 2 weeks!" Which is a possibility in this situation?
a. A single dose of a vaginal antifungal cream
b. A one-time infusion of amphotericin B
c. A single dose of a fluconazole (Diflucan) oral tablet
d. There is no better alternative to the suppositories.



Advese effects of Fungizone

vomiting anorexia headache acute infusion related fever and chills


A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?
a. "Chew the lozenges until they are completely dissolved."
b. "Let the lozenge dissolve slowly and completely in your mouth without chewing it."
c. "Rinse your mouth with water before taking the inhaler."
d. "Rinse your mouth with mouthwash after taking the inhaler."



The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.)
a. Administering the medication by rapid IV infusion
b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities
c. If adverse effects occur, reducing the IV rate gradually until they subside
d. Using an infusion pump for IV therapy
e. Monitoring the IV site for signs of phlebitis and infiltration
f. Administering premedication for fever and nausea



A patient who has a helminthic infection has a prescription for pyrantel (Antiminth). Which is one of the common adverse effects that the patient may experience while on this therapy?
a. Vertigo
b. Seizures
c. Diarrhea
d. Insomnia



A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation?
a. praziquantel (Biltricide)
b. pyrantel (Pin-X)
c. metronidazole (Flagyl)
d. ivermectin (Stromectol)



What will you administer with Biltricide to rid of the tapeworm?



A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine (Plaquenil)?
a. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on an empty stomach.
b. The drug is started 3 weeks before exposure but can be discontinued once she leaves the area.
c. The medication is taken only when she observes mosquito bites, because it can have toxic effects if taken unnecessarily.
d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is continued for 4 weeks after leaving the area.



A patient with late-stage HIV infection also has Pneumocystis jirovecii pneumonia. The nurse anticipates treatment with which medication for this pneumonia?
a. ivermectin (Stromectol)
b. atovaquone (Mepron)
c. praziquantel (Biltricide)
d. metronidazole (Flagyl)



Most common intestinal parasite



A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. The nurse will include which information in the teaching plan for this patient?
a. The urine may become dilute and pale during therapy.
b. Taking the medications with food reduces gastrointestinal upset.
c. The medications should be taken on an empty stomach.
d. The drugs may be discontinued once the diarrhea subsides.



The nurse is reviewing antimalarial drug therapy with a patient and instructs the patient to watch for and report which potential adverse reactions?
a. Drowsiness
b. Insomnia
c. Visual disturbances
d. Constipation



A patient is being evaluated for a possible helminthic infection. The nurse knows that which statement about anthelmintic therapy is true?
a. The drugs may cause severe drowsiness.
b. Anthelmintics are very specific in their actions.
c. Anthelmintics are effective against broad classes of infestations.
d. The drugs are used to treat protozoal infections such as intestinal amebiasis.



A patient is experiencing the exoerythrocytic phase of malaria. The nurse expects which drug to be used for this patient?
a. quinine
b. chloroquine (Aralen)
c. mefloquine (Lariam)
d. primaquine



A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which condition?
a. Lyme disease
b. Toxoplasmosis
c. Systemic lupus erythematosus
d. Intestinal tapeworms



Hydroxychloroquine (Plaquenil) is prescribed as part of malaria prophylaxis for a patient who will be traveling. The nurse will discuss which potential adverse effects with the patient? (Select all that apply.)
a. Diarrhea
b. Constipation
c. Insomnia
d. Dizziness
e. Rash
f. Headache

A, D, E, F