Exam #2 Flashcards
(415 cards)
1
Q
What are some of the reasons someone may be prescribed Hydrocodone?
A
They need a decrease in the severity of their pain or suppression of the cough reflex.
2
Q
What is the trade name of Hydrocodone?
A
Norco/Vicodin
3
Q
What classification is Hydrocodone associated with?
A
Opioid Analgesics
4
Q
What are the usual routes of Hydrocodone?
A
By mouth (PO) or By mouth ER (Extended Release)
5
Q
What is some of the patient teaching for Hydrocodone?
A
Take this medicine as directed. Potential abuse to this medication. Teach how to recognize respiratory depression. May cause drowsiness or dizziness. Change positions slowly. Notify of current medications. Advise important oral hygiene. Notify if pregnant.
6
Q
Why would you not allow someone to take Hydrocodone?
A
If the client is susceptible to drug abuse or vitals are abnormal.
7
Q
What are some potential side effects of Hydrocodone?
A
Respiratory Depression
Blurred Vision, Diplopia, Miosis
Urinary Retention
Confusion, dizziness, sedation, nausea, constipation, dyspepsia.
8
Q
What is the antidote for Hydrocodone?
A
Naloxone
9
Q
What drugs does Hydrocodone have interactions with?
A
Trazodone, alcohol, tramadol, nalbuphine, antipsychotics, mirtazapine, etc.
10
Q
What do you evaluate or look for after someone has taken Hydrocodone?
A
Look for suppression of nonproductive cough, and also see if this medication has decreased their severity in pain.
11
Q
What do you assess before administering Hydrocodone?
A
Assess vitals, bowel function. Assess the type, location, and severity of pain. Assess for opioid addiction or abuse in the past.
12
Q
What are some lab value alterations that may be caused by Hydrocodone?
A
A rise in plasma amylase and limase concentrations may occur.
13
Q
What is the trade name for Hydrochlorothiazide?
A
HCTZ/Microzide
14
Q
What classification is Hydrochlorothiazide associated with?
A
Antihypertensives/Diuretic
15
Q
What are the usual routes Hydrochlorothiazide is given?
A
By mouth (PO)
16
Q
What are some of the reasons someone may be given Hydrochlorothiazide?
A
May help with lowering BP in hypertensive patients and diuresis with mobilization of edema.
Promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium, and bicarbonate.
Increase excretion of sodium and water by inhibiting sodium reabsorption in the distal tube.
17
Q
What are some potential side effects of Hydrochlorothiazide?
A
Skin Cancer, Steven Johnson Syndrome
Pancreatitis
Dehydration, anorexia, cramping, hepatitis.
Dizziness, drowsiness, lethargy, weakness, nausea, vomiting.
18
Q
What is some of the patient teaching for Hydrochlorothiazide?
A
Take medicine same time everyday. Monitor weight biweekly. Change positions slowly. Use sunscreen. Undergo skin cancer screenings. Need Follow-up exams. Discuss dietary potassium requirements. Notify of current medications.
19
Q
What are some of the lab value alterations that may be caused by Hydrochlorothiazide?
A
Monitor electrolytes, potassium, blood glucose, BUN, serum creatinine, and uric acid.
20
Q
What are the drugs Hydrochlorothiazide has interactions with?
A
Antihypertensives, alcohol, digoxin, cholestyramine, colestipol, piperacillin, tazobactam.
21
Q
What do you assess before administering Hydrochlorothiazide?
A
Monitor vitals and weight. Assess for skin rash and for allergies.
22
Q
Why would you not give someone Hydrochlorothiazide?
A
If rash occurs!
23
Q
What do you evaluate or look for after administering Hydrochlorothiazide?
A
Look for a decrease in BP and decrease in edema.
24
Q
What is the trade name for Heparin?
A
Hepalean
25
What classification is Heparin associated with?
Anticoagulants
26
What are the usual routes Heparin is given?
Sub Q, IV
27
What are the reasons you would prescribe Heparin?
To prevent thrombus formation (clots), extension of existing thrombi.
28
What is the antidote for Heparin?
Protamine sulfate
29
What are the potential side effects of Heparin?
Alopecia, rash, urticaria.
Osteoporosis
Fever, hypersensitivity reactions
Bleeding, Heparin-Induced Thrombocytopenia (HIT)
30
What is some of the patient teaching for Heparin?
Report any symptoms of unusual bleeding or bruising. No meds with aspirin. Stay away from things that cause bleeding such as razors, knifes, etc. Report pregnancy and current medications.
31
What are some of the lab value alterations that may be caused by Heparin?
Monitor activated partial thromboplastin time. Monitor platelet count.
32
What drugs may have interactions with Heparin?
Streptokinase, digoxin, nicotine, warfarin, antihistamines, aspirin, dextran, cefotetan, thrombolytics, clopidogrel, tirofiban.
33
What do you assess before administering Heparin?
Asses for signs of bleeding and hemorrhage. Monitor for hypersensitivity reactions.
34
Why would you not allow someone to take Heparin?
If signs of bleeding, bruising, or hemorrhage occur.
35
What do you evaluate or look for after administering Heparin?
Patency of IV catheters.
Prevention of deep vein thrombosis and pulmonary emboli.
Prolonged partial thromboplastin time.
36
What is the trade name for Haloperidol?
Haldol
37
What classification is Haloperidol associated with?
Antipsychotics
38
What are the usual routes Haloperidol are given?
By mouth (PO), IM, IM decanoate
39
What are the reasons someone may be given Haloperidol?
Diminished signs and symptoms of psychoses.
Improved behavior in children with Tourettes syndrome or other behavioral problems.
40
What are some potential side effects of Haloperidol?
Seizures, confusion, drowsiness, restlessness, tardive dyskinea.
Neuroleptic Malignant Syndrome.
Agranulocytosis
Torsades de Pointes, hypotension, tachycardia.
41
What is some of the patient teaching for Haloperidol?
Take medicine as directed. Inform possibility of extrapyramidal symptoms. Change positions slowly. May cause drowsiness. Notify of current medications. No alcohol. Use sunscreen. Use frequent mouth rinses. Notify if pregnant. Need follow-up exams.
42
What drugs can Haloperidol possible have interactions with?
Antihypertensives, alcohol, antihistamines, antidepressants, atropine, opioid analgesics, sedatives/hypnotics, etc.
43
What needs to be assessed before administration of Haloperidol?
Mental status, assess positive symptoms of schizophrenia. Assess weight and vital signs. Monitor intake and output. Assess for fall risks.
44
Why would you not administer Haloperidol to someone?
If mental health is not improving.
45
What do you evaluate or look for after administering Haloperidol?
Decrease in hallucinations, insomnia, agitation, hostility, and delusions.
Decreased Tics.
Improved behavior in children with severe behavior problems.
46
What is the trade name for Gabapentin?
Neurotin
47
What classification is Gabapentin associated with?
Anticonvulsant
48
What are the usual routes Gabapentin is given?
PO-IR (Immediate Release), PO-SR (Sustained Release)
49
What are the reasons someone would be given Gabapentin?
To decrease incidence of seizures.
Decrease postherpeutic pain.
Decrease leg restlessness.
50
What are some of the potential side effects of Gabapentin?
Steven-Johnson Syndrome
Rhabdomyolysis
Hypersensitivity Reactions
Suicidal Thoughts
51
What is some of the patient teaching for Gabapentin?
Take medicine as directed. Do not take this med within 2 hrs of antacid. May cause dizziness or drowsiness. Notify if pregnant and any current medications. Notify risk of respiratory depression. Notify risk of suicidal thoughts.
52
What drugs may have interactions with Gabapentin?
Antacids, antihistamines, alcohol, sedative/hypnotics, hydrocodone.
53
What needs to be assessed before administering Gabapentin?
Monitor behavior changes. Seizures, pain, migraines. Look for a good change.
54
Why would you not administer Gabapentin?
If having suicidal thoughts!
55
What needs to be evaluated or looked at after administering Gabapentin?
Desired frequency or cessation of seizures. Decreased pain. Increased mood stability. Decreased frequency of headaches. Decreased effects of restless leg syndrome.
56
What is the trade name for Fentanyl?
Duragesic
57
What classification is Fentanyl associated with?
Opioid Analgesics
58
What are the usual routes Fentanyl is given?
Transdermal
59
What are the reasons you would administer Fentanyl?
To decrease the severity of chronic pain.
60
What is the antidote for Fentanyl?
Naloxone
61
What food interacts with Fentanyl?
Grapefruit Juice
62
What are some of the potential side effects of Fentanyl?
Bradycardia, hypotension.
Anorexia, constipation, dry mouth, vomiting, nausea.
Apnea, Respiratory Depression.
Confusion, sedation, weakness, sweating.
63
What is some of the patient teaching for Fentanyl?
Instruct how often to take med. Instruct correct application and disposal of patch. Advise about addiction.
64
What lab value alterations can be caused by Fentanyl?
May increase plasma amylase and lipase levels.
65
What drugs may interact with Fentanyl?
Antidepressants, other analgesics.
66
What needs to be assessed before administration of Fentanyl?
Find out about pain, vital signs, bowel function, risk of addictions or abuse. Notify if pregnant or breastfeeding. Watch for symptoms of respiratory depression.
67
Why would you not administer Fentanyl?
Breathing problems, drug abuse past, constipation.
68
What needs to be evaluated or looked at after the administration of Fentanyl?
Decreased in severity of pain.
69
What is the trade name for Enoxaparin?
Lovenox
70
What classification is Enoxaparin associated with?
Anticoagulant
71
What are the usual routes Enoxaparin is given?
Subcutaneous
72
What are the reasons someone would be prescribed Enoxaparin?
Prevention of blood clots.
73
What are the reasons someone would be prescribed Enoxaparin?
Prevention of Blood clots.
74
What is the antidote for Enoxaparin?
Protamine Sulfate 1mg for each mg of enoxaparin should be administered by slow IV injection.
75
What are some of the potential side effects of Enoxaparin?
Bleeding, anemia.
Dizziness, headache, insomnia.
Nausea, vomiting, fever.
Edema, rash
76
What is some of the patient teaching for Enoxaparin?
Teach proper injection care, and disposal of equipment. Report unusual bleeding, bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing. Do not take aspirin, naproxen, ibuprofen. Notify before dental or medical treatment or surgery. Notify if pregnant or breastfeeding.
77
What drugs may have interactions with Enoxaparin?
Warfarin, aspirin, dipyridamole, some penicillins, clopidogrel, dextran, tirofiban, abciximab, eptifibatide, other anticoagulants.
78
What needs to be assessed before administration of Enoxaparin?
Watch for increased clots, and inflammation of injection site.
79
Why would someone not be administered Enoxaparin?
Unusual bleeding or bruising occurs.
80
What needs to be evaluated or looked at after administering Enoxaparin?
Prevention of blood clots and resolution of acute deep vein thrombosis.
81
What is the trade name for Docusate Sodium?
Colace
82
What classification is Docusate Sodium associated with?
Laxative
83
What are the usual routes Docusate Sodium is given?
By mouth (PO) and Rectal
84
What are some of the reasons someone may be prescribed Docusate Sodium?
Needs stool softened to allow regular bowel movements.
85
What are some potential side effects of Docusate Sodium?
Throat Irritation
Mild cramps, diarrhea
Rashes
86
What is some of the patient teaching for Docusate Sodium?
Only use short-term! Encourage bulk diet, fluid intake increase, increase in mobility. Do not use when having abdominal pain, nausea, vomiting, or fever. Advise to not take other laxatives 2 hr within Docusate Sodium.
87
What drugs may interact with Docusate Sodium?
None!
88
What needs to be assessed before administering Docusate Sodium?
Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.
89
Why would someone not be administered Docusate Sodium?
If the client is having abdominal pain, nausea, vomiting, fever.
90
What needs to be evaluated or looked at after administration of Docusate Sodium?
Hopefully will see relief and client will have a soft, formed bowel movement usually within 24-48 hours.
91
What is the trade name for Hydromorphone?
Dilaudid
92
What classification is Hydromorphone associated with?
Opioid Analgesics
93
What are the usual routes that Hydromorphone are given?
PO-IR (Immediate Release), PO-ER (Extended Release), Subcut, IM, IV, Rectal
94
What is the antidote for Hydromorphone?
Naloxone
95
What are some of the potential side effects of Hydromorphone?
Respiratory Depression
Adrenal Insufficiency
Hypotension, Bradycardia
Confusion, sedation, dizziness, dry mouth, nausea, vomiting
96
What is some of the patient teaching for Hydromorphone?
Advise about potential abuse. Learn to recognize respiratory depression. May cause drowsiness, dizziness. Change positions slowly. Avoid alcohol. Notify about current medications.
97
What are the lab value alterations that may be caused by Hydromorphone?
May rise plasma amylase and lipase concentrations.
98
What drugs may interact with Hydromorphone?
MAO, antipsychotics, alcohol, tramadol, trazodone, linezolid, mirtazapine, etc.
99
What needs to be assessed before the administration of Hydromorphone?
Assess vitals, bowel function. Assess the type, location and intensity of pain. Assess for abuse or addiction signs and symptoms.
100
Why would someone not be able to take Hydromorphone?
If abuse or addiction occurs or vitals are abnormal.
101
What needs to be evaluated or looked at after the administration of Hydromorphone?
Decrease in severity of pain and suppression of cough.
102
What is the trade name for Furosemide?
Lasix
103
What classification is Furosemide associated with?
Diuretic/Water Pill
104
What are the usual routes that Furosemide is given?
PO, IM, IV
105
What are some of the potential side effects of Furosemide?
Steven-Johnson Syndrome, Toxic Epidermal Necrolysis, Erythema Multiforme
Aplastic Anemia, Agranulocytosis
Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia
Hyponatremia, hypovolemia, metabolic alkalosis.
106
What are some of the reasons someone would be administered Furosemide?
Hypertension
Edema due to heart failure, hepatic impairment, or renal disease
107
What needs to be evaluated or looked at after the administration of Furosemide?
Decrease in Edema.
Decrease in BP.
Increase in urinary output.
108
What needs to be assessed before administration of Furosemide?
Assess fluid status and monitor weight daily. Monitor BP. Assess fall risks. Assess for allergy to sulfonamides. Assess for tinnitus and hearing loss. Assess for skin rash.
109
Why would someone not be administered Furosemide?
If skin rash occurs, or if allergy appears.
110
What is some of the patient teaching for Furosemide?
Advise to take medicine as directed. Change positions slowly. Advise to ask about potassium since it could possibly drop potassium levels. If gained more than 3 lbs in 1 day inform health care professional. Notify of current medications. Use sunscreen. Notify health care professionals immediately if rash or any other symptoms occur. Advise diabetic patients to monitor glucose levels as levels may rise. Notify is pregnant. Needs follow-up appointments.
111
What drugs may have interactions with Furosemide?
Antihypertensives, alcohol, diuretics, corticosteroids, digoxin, lithium, cisplatin, etc.
112
A nurse receives a prescription for phenobarbital for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day should the nurse expect to administer the medication?
A. One
B. Two
C. Three
D. Four
A. One
Medications with long half-lives remain at their therapeutic levels between doses for long periods of time. Expect to administer this medication once a day.
113
A nurse is reviewing medication metabolism. Which of the following factors should the nurse determine as a reason to administer lower medication dosages? (Select all that Apply)
A. Increased renal excretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
C. Liver failure
Liver failure decreases metabolism and thus increases the concentration of a medication. This requires decreasing the dosage.
E. Concurrent use of medication the same pathway metabolizes
When the same pathway metabolizes two medications, they compete for metabolism, thereby increasing the concentration of one or both medications. This requires decreasing the dosage of one or both medications.
114
A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply)
A. Have the client lie on one side
B. Ask the client to look up at the ceiling
C. Tell the client to blink when the drops enter the eye
D. Drop the medication into the client's conjunctival sac
E. Instruct the client to close the eye gently after instillation
B. Ask the client to look up at the ceiling
The client should look upward to keep the drops from falling onto the cornea.
D. Drop the medication into the client's conjunctival sac
Drop the medication into the conjunctival sac to promote distribution.
E. Instruct the client to close the eye gently after instillation
The client should close the eye gently to promote distribution of the medication.
115
A nurse is reinforcing teaching to a client about transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands?
A. "I will clean the site with an alcohol swab before I apply the patch."
B. "I will rotate the application sites weekly."
C. "I will apply the patch to an area of skin with no hair."
D. "I will place the new patch on the site of the old patch."
C. "I will apply the patch to an area of skin with no hair."
The client should apply the patch to a hairless area of skin to promote absorption of the medication.
116
A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
B. Verify that the client has been taking the medication for 24hr before obtaining a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min later.
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
To verify trough levels of a medication, obtain a blood specimen immediately before administering the next dose of medication.
117
A nurse is preparing a client's medications. Which of the following actions should the nurse take in following legal practice guidelines? (Select all that apply)
A. Reinforce teaching with the client about the medication.
B. Determine the dosage.
C. Monitor for adverse effects.
D. Lock compartments for controlled substances.
E. Determine the client's insurance status.
A. Reinforce teaching with the client about the medication.
Reinforcing teaching with the client about the medication is part of the rights of medication administration.
C. Monitor for adverse effects.
Monitor for adverse effects as part of the rights of medication administration.
D. Lock compartments for controlled substances.
Lock controlled substance in a drawer, cart, or other compartment to prevent misuse.
118
A nurse is preparing to administer digoxin to a client who states, " I don't want to take that medication. I do not want one more pill." Which of the following responses should the nurse make?
A. "Your physician prescribed it for you, so you really should take it."
B. Well, let's just get it over quickly then."
C. "Okay, I'll just give you your other medications."
D. "Tell me your concerns about taking this medication."
D. "Tell me your concerns about taking this medication."
Although clients have the right to refuse a medication, this response is correct in determining the reason for refusal by asking about the client's concerns. Then information can be provided about the risk of refusal and facilitate and informed decision. At that point, if the client still exercises their right to refuse a medication, notify the provider and document the refusal and the actions taken.
119
A nurse is reviewing a client's prescribed medications. Which of the following situations represents a contraindication to medication administration?
A. The client drank grapefruit juice, which could reduce a medication's effectiveness.
B. The medication has orthostatic hypotension as an adverse effect.
C. A medication is approved for ages 12 and older, and the client is 8 years old.
D. An anti anxiety medication that has an adverse effect of drowsiness is prescribed as a preoperative sedative.
C. A medication is approved for ages 12 and older, and the client is 8 years old.
Age is one factor that can be a contraindication to medication administration. Contraindications are findings that indicate the client should not receive a medication and are different from instances where an undesirable effect or more monitoring are needed.
120
A nurse is collecting data from a client before administering medications. Which of the following data should the nurse obtain? (Select all that apply)
A. Use of herbal products
B. Daily fluid intake
C. Ability to swallow
D. Previous surgical history
E. Allergies
A. Use of herbal products
Inquire about the client's use of herbal products, which often contain caffeine, prior to medication administration because caffeine can affect medication biotransformation.
C. Ability to swallow
Determine the client's ability to swallow to see what route or formulation of the medication the client requires.
E. Alleriges
Inquire about food allergies during the pre-assessment to identify any potential reactions or interactions.
121
A nurse is working with a newly licensed nurse who is administering medications to clients. Which of the following actions should the nurse identify as in indication that the newly hired nurse understands medication error prevention?
A. Taking all medications out of the unit-does wrappers before entering the client's room.
B. Checking the prescription when a single dose requires administration of multiple tablets.
C. Administering a medication, then looking up the usual dosage range.
D. Relying on another nurse to clarify a medication prescription.
B. Checking the prescription when a single dose requires administration of multiple tablets.
If a single dose requires multiple tablets, it is possible that an error has occurred in the prescription or transcription of the medication. This action could prevent a medication error.
122
A nurse is observing a client's IV infusion site. Which of the following findings should the nurse identify as indications of phlebitis? (Select all that apply)
A. Pallor
B. Dampness
C. Erythema
D. Coolness
E. Pain
C. Erythema
Erythema and warmth at the insertion site are manifestations of phlebitis.
E. Pain
Pain and burning at the insertion site are manifestations of phlebitis.
123
A nurse is assisting with the initiation of IV therapy for an older adult client. Which of the following actions should the nurse plan to take?
A. Use a disposable razor to remove excess hair on the extremity.
B. Select the back of the client's hand to insert the IV catheter.
C. Distend the veins by using a blood pressure cuff.
D. Direct the client to raise their arm above the heart.
C. Distend the veins by using a blood pressure cuff.
Distend the veins using a blood pressure cuff to reduce overfilling of the vein, which can result in a hematoma.
124
A nurse monitoring the IV catheter insertion site for a client receiving a nonvesicant solution and notes swelling at the site with decrease skin temperature. Which of the following actions should the nurse take? (Select all that apply)
A. Stop the infusion
B. Start a new IV access distal to this site.
C. Apply warm compresses to the insertion site.
D. Elevate the client's arm.
E. Obtain a specimen for culture at the insertion site.
A. Stop the infusion
Decreases temperature and swelling at the insertion site are manifestations of IV infiltration. Stop the infusion and start a new line in the other extremity.
C. Apply warm compresses to the insertion site.
Apply a warm or cold compress for a client who is experiencing manifestations of an IV infiltration, depending on the solution.
D. Elevate the client's arm
Elevate the arm of a client who is experiencing edema with an infiltration.
125
A nurse is preparing to administer a medication the nurse has never administered previously. Which of the following information should the nurse identify as a contraindication to administering the medication? (Select all that apply)
A. Decrease heart rate is an adverse effect of the medication.
B. The client is allergic to a component of the medication.
C. The client is five years younger than the age requirement for the medication.
D. The client's kidney function tests indicate a need for a dosage reduction.
E. The client will need additional monitoring of liver function if the medication is administered long-term.
B. The client is allergic to a component of the medication.
An allergy to a component of the medication is a contraindication because taking the medication will cause client harm.
C. The client is five years younger than the age requirement for the medication.
Not meeting age or weight requirements for a medication is a contraindication to medication administration.
126
A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago, they developed a rash. Which of the following actions should the nurse take?
A. Administer the prescribed dose.
B. Withhold the medication.
C. Ask the provider to change the prescription to an oral form.
D. Administer an oral antihistamine at the same time.
B. Withhold the medication.
Withhold the medication and notify the provider of the client's previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider.
127
A nurse is comparing a newly prescribed medication to a client's current medications. Which of the following interactions should the nurse identify as increasing the risk of medication toxicity?
A. One of the client's current medications minimizes the adverse effects the new medication.
B. The new medication increases the effectiveness of one of the clients current medications.
C. One of the client's current medications has a similar adverse effect as the new medication.
D. The new medication decreases the rate of metabolism of another medication.
D. The new medication decreases the rate of metabolism of another medication.
When metabolism of a medication is reduced, it remains active in the body for longer time periods or at higher levels.
128
A nurse is reviewing a client's health record and notes that the client experienced permanent extrapyramidal symptoms (EPS) caused by a previous medication. The nurse should recognize that the medication affected which of the following systems in the client?
A. Cardiovascular
B. Immune
C. Central Nervous
D. Gastrointestinal
C. Central Nervous
EPS are movement disorders that can be caused by a number of central nervous system medications (typical antipsychotic medications).
129
A nurse is caring for a client who is experiencing anaphylaxis. Which of the following medications should the nurse expect to administer?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Naloxone
C. Antihistamines
D. Anticholingerics
C. Antihistamines
Antihistamines medications (diphenhydramine) reduce angioedema and urticaria associated with anaphylaxis.
130
Pharmacokinetics
Refers to how medications travel through the body. They undergo variety of biochemical processes that result in absorption, distribution, metabolism, and excretion.
131
Absorption
The transmission of medications from the location of administration (gastrointestinal [GI] tract, muscle, skin, mucous membranes, or subcutaneous tissue) to the bloodstream.
132
Distribution
The transportation of medications to sites of action by bodily fluids.
133
Metabolism
(Biotransformation) changes medications into less active or inactive forms by the action of enzymes. This occurs primarily in the liver, but it also takes place in the kidneys, lungs, intestines, and blood.
134
What are the factors influencing the rate of medication metabolism?
Age
Increase in some medication-metabolizing enzymes
First-pass effect
Similar metabolic pathways
Nutritional status
135
Metabolism Factor: Age
Infants have a limited medication-metabolizing capacity. The aging process also can influence medication metabolism, but varies with the individual. In general, hepatic medication metabolism tends to decline with age. Older adults require smaller doses of medications due to the possibility of accumulation in the body.
136
Metabolism Factor: Increase in some medication-metabolizing enzymes
This can metabolize a particular medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level. It can also cause an increase in the metabolism of other concurrent-use medications.
137
Metabolism Factor: First-pass effect
The liver inactivates some medications on their first pass through the liver, and thus they require a nonenteral route (sublingual, IV) because of their high first-pass effect.
138
Metabolism Factor: Similar metabolic pathways
When the same pathway metabolizes two medications, it can alter the metabolism of one or both of them. In this way, the rate of metabolism can decrease for one or both of the medications, leading to medication accumulation.
139
Metabolism Factor: Nutritional status
Clients who are malnourished can be deficient in the factors that are necessary to produce specific medication-metabolizing enzymes, thus impairing medication metabolism.
140
Outcomes of Metabolism
Increased renal excretion of medication
Inactivation of medications
Increased therapeutic effect
Activation of pro-medications (also called pro-drugs) into active forms
Decreased toxicity when active forms of medications become inactive forms
Increased toxicity when inactive forms of medications become active forms
141
Excretion
The elimination of medications from the body, primarily through the kidneys. Elimination also takes place through the liver, lungs, intestines and exocrine glands (such as in breast milk). Kidney dysfunction can lead to an increase in the duration and intensity of a medication's response, so it is important to monitor BUN and creatinine levels.
142
Therapeutic Index
Medications with a high (TI) have a wide safety margin. Therefore, there is no need for routine blood medication-level monitoring. Medications with a low TI require close monitoring of medication levels.
143
Half-Life
Refers to the time for the medication in the body to drop by 50%. Liver and kidney function affect half-life. It usually takes four half-lives to achieve a steady blood concentration (medication intake = medication metabolism and excretion).
144
Short Half-Life
-Medications leave the body quickly(4 to 8 hrs)
-Short-dosing interval or MEC drops between doses
145
Long Half-Life
-Medication leave the body more slowly: over more than 24 hr, with a greater risk for medication accumulation and toxicity.
-Medications can be given at longer intervals without loss of therapeutic effects.
-Medications take a longer time to reach a steady state.
146
Pharmacodynamics
Describes the interactions between medications and target cells, body systems, and organs to produce effects. These interactions result in functional change that are the mechanism of action of the medication. Medications interact with cells on one of two ways or in both ways.
147
Agonists
Medications that bind to or mimic the receptor activity that endogenous compounds regulate. For example, morphine is an agonist because it activates the receptors that produce analgesia, sedation, constipation, and other effects. (Receptors are the medication's target sites on or within the cells.)
148
Antagonists
Medications that can block the usual receptor activity that endogenous compounds regulate or the receptor activity of other medications. For example, losartan, an angiotensin II receptor blocker, is an antagonist. It works by blocking angiotensin II receptors on blood vessels, which prevents vasoconstriction.
149
Partial Agonists
Act as agonists and antagonists, with limited affinity to receptor sites. For example, nalbuphine acts as an antagonists at mu receptors and an agonist at kappa receptors, causing analgesia with minimal respiratory depression at low doses.
150
Oral or Enteral Medications
The most common route that comes in tablets, capsules, liquids, suspensions, elixirs, lozenges.
151
Sublingual
Medication given under the tongue.
152
Buccal
Medication given between the cheek and the gum. Directly enters the bloodstream and bypasses the liver.
153
Topical Medications
Medications directly applied to the mucous membranes or skin. Includes powders, sprays, creams, ointments, pastes, oil-and suspension-based lotions.
154
Transdermal Medications
Medication in a skin patch for absorption through the skin, producing systemic effects.
155
Inhalation Medications
Administered through metered-dose inhalers (MDI) or dry-powder inhalers (DPI).
156
Chemical Name
The name of the medication that reflects its chemical composition and molecular structure (isobutylphenylpropanoic acid).
157
Generic Name
The official or nonproprietary name the United States Adopted Names Council gives a medication. Each medication has only one generic name (Ibuprofen).
158
Trade Name
The brand or proprietary name the company that manufactures the medication gives it. One medication can have multiple trade names (Advil, Motrin).
159
Uncontrolled Substances
Require monitoring by a provider, but do not generally pose risks of misuse and addiction. Antibiotics are an example of uncontrolled prescription medications.
160
Controlled Substances
Have a potential for misuse and dependence an have a "Schedule" classification. Heroin is in Schedule 1 and has no medical use in the United States. Medications in Schedules II through V have legitimate applications. Each subsequent level has a decreasing risk of misuse and dependence. For example, morphine is a Schedule II medication that has a greater risk for misuse and dependence than phenobarbital, which is a Schedule IV medication.
161
Intravenous Therapy (IV)
Involves administering fluids via an IV catheter to administer medications, supplement fluid intake, or give fluid replacement, electrolytes, or nutrients.
162
What is the antidote for Acetaminophen?
Acetylcysteine (Mucomust)
163
What is the antidote for Anticholingerics?
Physostigmine
164
What is the antidote for Benzodiazepines?
Flumazenil (Romazicon)
165
What is the antidote for Calcium Channel Blockers?
Calcium Gluconate
166
What is the antidote for Cyanide or Nitrate?
Methylene Blue
167
What is the antidote for Digoxin (Lanoxin)?
Digibind
168
What is the antidote for Iron?
Deferoxamine (Desfersal)
169
What is the antidote for Insulin?
Glucagon
170
What is the antidote for Lead?
Succimer (Chemet)
171
What is the antidote for Magnesium Sulfate?
Calcium Gluconate
172
What is the antidote for Opioid?
Naloxone (Narcan)
173
What is the antidote for Warfarin?
Vitamin K
174
What is the antidote for Streptokinase?
Amicar
175
What is the antidote for Beta Blockers?
Glucagon
176
What is the antidote for Aprepitant?
Neuokinin
177
What is the antidote for Aspirin?
Active Charcoal
178
What is the antidote for Lovenox
Flumazenl
179
What is the antidote for Lorazepam?
Romazicon
180
Drug Interactions
One drug modifies the action of another.
181
Polypharmacy
Many medications for one client are prescribed.
182
Side Effects
Unintended actions, expected for the medication.
183
Adverse Effects
Unexpected, undesirable effects with more serious consequences.
184
Peak
Highest concentration of drug in blood.
185
Trough
Lowest concentration of drug in blood.
186
Anaphylaxis
Severe allergic reaction.
187
Therapeutic Range
Levels of the drug in the blood that will produce the desired effect of the drug.
188
Black Box Warning
Strongest warning from FDA, serious side effects or life-threatening risks.
189
Toxic Effects
Harmful levels of the drug in the blood that rise above therapeutic ranges and cause unintended damage.
190
7 Right of Medication Administration
Right Patient
Right Drug
Right Dose
Right Time
Right Route
Right Reason
Right Documentation
191
Schedule 1
Drugs not currently accepted for medical use in US (some opioids, LSD, heroin, etc.)
192
Schedule II
Accepted in US, high potential for abuse (Dilaudid, Methadone, Oxycodone, Oxycontin/Percocet)
193
Schedule III
Accepted, less of a change of abuse.
194
Schedule IIII
Same
195
Schedule V
Same as IIII
196
Medication Reconciliation
Reviewing a clients complete medication regimen at admission, transfer, and discharge.
197
MAR
Medication Administration Record
198
eMAR
Electronic Medication Administration Record
199
Medications can be affected by:
Genetics
Age
Sex
Race
Renal Function
Hepatic Function
Other Diagnosis
Other Variations (Brand versus Generic)
200
Causes of Medication Errors
Communication
High Alert Medications
How the medication is written or typed
What medication is stored where and how it is packaged
Miscalculation
Incorrect Administration
Lack of Client Education
201
CAM
Complimentary and Alternative Medicine
202
Kilo
1,000
203
Milli
0.001
204
5mL
1 tsp
205
15mL
1 tbsp
206
30mL
1 oz
207
240mL
1 cup
208
1kg
2.2lbs
209
2.5 cm
1 in
210
1ft
12in
211
1cm
10mm
212
m
meter
213
cm
centimeter
214
mm
millimeter
215
g
gram
216
kg
kilogram
217
mg
milligram
218
mcg
microgram
219
lb
pound
220
L
liter
221
mL
milliliter
222
tsp
teaspoon
223
Tbsp
tablespoon
224
oz
ounce
225
gtt
drop
226
PO
By mouth
227
SL
Sublingual
228
OD
Right eye
229
OS
Left eye
230
OU
Both eyes
231
AD
Right ear
232
AS
Left ear
233
AU
Both ears
234
ID
Intradermal
235
IM
Intramuscular
236
IV
Intravenous
237
PT
Per tube
238
INH
Inhalation
239
NEB
Nebulizer
240
PR
Rectally
241
Sub Q, Subcue, Subcut
Subcutaneous
242
QD
Once daily
243
BID
Twice daily
244
TID
Three times daily
245
QID
Four times daily
246
QOD
Every other day
247
PRN
As needed with reason
248
Q2H
Every two hours
249
Q2HP
Every 2 hrs PRN
250
XI
Once
251
STAT
Now
252
AM
Morning
253
HS
Bedtime
254
AC
Before meals
255
ACB
Before breakfast
256
ACL
Before lunch
257
ACS
Before supper
258
PC
After meals
259
CC
With meals
260
RX
Prescription or prescribe
261
Recon
Reconstitute (Mix for Solution)
262
mg/mL
Milligrams per Milliliter
263
NS
Normal Saline
264
Phlebitis
Inflammation of the inner layer, or intimate, of a vein.
265
Extravasation
Leakage of vesicant IV fluid or medication into the tissue surrounding the IV insertion site; vesicant means that is causes blistering, necrosis, and sloughing of tissue.
266
Thrombophlebitis
Inflammation of a vein in conjunction with the formation of a thrombus.
267
Localized Infection
Infection at the IV cannula insertion site.
268
Septicemia
Life-threatening infection of the bloodstream.
269
Severed Cannula
A piece of the IV cannula breaks off inside the vein.
270
Air Embolism
Obstruction of a blood vessel by an air bubble traveling through the circulatory system.
271
Speed Shock
Shock caused by rapid IV infusion of medication/solution.
272
Circulatory Fluid Overload
Excessive fluid volume within the cardiovascular system.
273
Higher the Number of the Needle
The smaller the needle is.
274
Holistic Approach to Nursing Care
Involves healing the mind, body, soul of our clients. It involves thinking about and assisting clients with the effects of illness on the body, mind, emotions, spirituality, religion, and personal relationships.
275
Assessment and Data Collection: Signs
-Abnormalities that can be verified by repeat examination.
-Objective Data
-What can be observed
-Ex. Fever, heart murmur, wound, etc.
276
Assessment and Data Collection: Symptoms
-What the client states is occurring.
-Cannot be verified by examination.
-Subjective Data
-What the subject states.
-Ex. Nausea, pain level, dizziness, etc.
277
ABC's
Airway, Breathing, Circulation
278
General Adaption Syndrome (Stress Syndrome)
3 Stages
-Alarm
-Resistance
-Exhaustion
279
Stress Signs
-Rapid, shallow breathing
-Dry Mouth
-Diaphoresis
-Shakiness, tremors
-Restlessness
-Increased Pulse
-Muscle tension
-Rapid Speech
-Frequent Urination
280
Stress Symptoms
-Dizziness
-Anxiety
-Irritability
-Nausea
-Changes in appetite
-Feeling of shortness of breath
-Chest pain or pain in other parts of the body
281
Sources of Stress
-Chronic illness or injury
-Acute illness or injury
-Work
-School
-Family or Friends
-Mental, behavioral, emotional or spiritual health issues
-Finances
-Time
-Role Changes
-Environmental Factors
282
Regular Temperature Averages
96.8-100.4 F
283
Regular Pulse Averages
60-100 beats per minutes (bpm)
284
Regular Respiratory Rate Averages
12-20 beats per minute (bpm)
285
Regular Oxygen Saturation Averages
91-100%
286
Regular Blood Pressure Averages
Less than 120/80
Can be too low which is 90/40
287
Afebrile
No Fever
288
Febrile/Pyrexia
Fever
289
Hyperpyrexia
High Fever
290
Diaphoresis
Excessive sweat production
291
Hypothermia
Cold, below 95 degrees F
292
Hyperthermia
Hot, above 102.2 degrees F
293
Radial Pulse
Felt in the wrist.
294
Carotid Pulse
Felt on the side of your neck to the side of the windpipe.
295
Apical Pulse
Felt on your chest under your left nipple.
296
Pedal Pulse
Felt on the dorsal aspect of the foot.
297
Tachycardia
Rapid pulse rate (greater than 100 bpm).
298
Bradycardia
Slow pulse rate (lower than 60 bpm).
299
Arrhythmia
Irregular pulse rate due to an abnormal heartbeat.
300
Pulse Rate can be affected by...
Age, physical activity, blood pressure, drugs, emotions, blood loss, changes in body temperature, pain, and other factors.
301
Pulse Strength
-0: Absent
-1+: Diminished
-2+: Normal, Brisk
-3+: Increased
-4+: Bounding
302
S1, S2 Heart Sounds
Normal heart sounds
303
S3, S4 Gallop
Extra heart sounds
304
Murmurs
Blowing or swishing sound heard over the heart, best heard with the bell of the stethoscope.
305
Thrills
Vibration you can feel, rare, accompany murmurs or other abnormalities.
306
Bruits
Blowing or swishing sounds heard over blood vessels, listen with the bell.
307
Tachypnea
Rapid respirations
308
Bradypnea
Slow respirations
309
Dyspnea
Difficulty breathing
310
Apnea
No respirations
311
Inspiration
Breathe in, inhalation
312
Expiration
Breathe out, exhalation
313
Factors that affect respiratory rate include...
Age, emotions, pain, physical activity, fever, drugs, illness, and others.
314
Hyperventilation
Pattern that is too rapid and or deep.
315
Hypoventilation
Pattern that is too slow and/or shallow.
316
Cheyne-Stokes
Respirations that become faster and deeper, then slower, alternates with periods of apnea.
317
Kussmaul's
Faster and deeper respirations without pauses.
318
Retractions
Muscles of the chest wall and/or abdomen moving inward with inhalation, cue to work of breathing.
319
Nail Flaring
Widening of the nostrils during inhalation, cue to hypoxia.
320
Cyanosis
Blue discoloration of the skin or mucous membranes, cue to hypoxia.
321
Crepitus
Crackly feeling of the skin, like rice krispies, cue to pneumothorax or punctured lung.
322
Bronchial
Loud, high pitched, heard over trachea, expiration longer then inspiration.
323
Bronchovesicular
Medium pitched, blowing sounds, heard over bronchial tubes and bronchioles, expiration equal to inspiration.
324
Vesicular
Soft, low pitched, heard over peripheral areas of the lungs, inspirations longer than expiration.
325
Crackled or Rales
Fine to coarse bubbly sounds, rice krispies sound, indicates fluid.
326
Wheezes
High pitched musical sounds, indicates airway constriction or obstruction.
327
Stridor
High pitched barking sounds, indicates more emergent airway constriction or obstruction.
328
Rhonchi
Coarse, low pitched rumbling sounds, indicates fluid or mucous.
329
Pleural Friction Rub
Dry, grating, or rubbing sounds, indicates inflammation of the lung lining, can be painful.
330
Absence of Breath Sounds in the Presence of Respirations Indicate...
Collapsed or punctured lung, absence of lung lobe due to surgical removal.
331
You can apply oximeter to what places?
Finger, toe, and ear.
332
Hypoxia
Decrease oxygen in the tissues.
333
Hypoxemia
Decreased oxygen in the blood (when you see -emia think blood.)
334
Anoxia
No oxygen
335
Hypercapnia
Increased carbon dioxide.
336
Hypotension
Low blood pressure
337
Hypertension
High Blood Pressure
338
Orthostatic Hypotension
Blood pressure falls with position changes from lying, to sitting, to standing.
339
White Coat Syndrome
Blood pressure is higher in office or hospital settings due to anxiety.
340
Acute Pain
Short duration, hours to days.
341
Chronic Pain
Long duration, months to years.
342
Neuropathic
Related to dysfunction of the nervous system, can often be burning, numbness, tingling, dull, heavy pressure.
343
Phantom Pain
Pain after the loss of a body part where the body part would be.
344
Pain Threshold
Point at which a person feels pain.
345
Pain Tolerance
Level of pain a person can tolerate.
346
Pain Intensity
Pain scale, appropriate scale for client.
347
Pain Location
Where is the pain located?
348
Pain Quality
How does it feel? Sharp, dull, burning, achy, cramping, stabbing, tearing, etc.
349
Pain Timing
When did the pain begin? Does it come and go or is it constant? Have you felt this pain before?
350
Aggravating Factors
What makes the pain worse? Eating, walking, sitting, standing, etc.
351
Relieving Factors
What makes the pain better? Medications, changing positions, rest, eating, bowel movements, etc.
352
Accompanying Symptoms
Are you having any other symptoms? Nausea, vomiting, dizziness, sweating, etc.
353
Acceptable Level of Pain
What level of pain is acceptable?
354
Opioid
Addictive medications such as Morphine, Vicodin, etc.
355
Non-opioid
Non addictive medications such as Ibuprofen, Tylenol, Aspirin, etc.
356
Adjuvent
Anticonvulsants, anti anxiety agents, antihistamines, steroids, etc.
357
Patient-Controlled Analgesic (PCA)
A pump that the patient controls with provider-ordered settings.
358
Pain Patch
Patch applied to skin, releases pain medication continuously.
359
Non-Pharmacological Treatments (Non Medications)
-Relaxation Technique
-Electrical Nerve Stimulation
-Distraction
-Imagery
-Massage
-Acupuncture/Acupressure
-Binders/Braces
-Hydrotherapy
-Hypnosis
-Physical Therapy
-Heat/Cold
360
Active Range of Motion (AROM)
Individual can actively move limbs.
361
Passive Range of Motion (PROM)
Individual cannot actively more, limbs must be moved by another person.
362
Contractures
Inability to straighten an appendage actively or passively.
363
Perfusion
Circulation of blood to extremities.
364
4 Bowel Quadrants
RLQ, RUQ, LUQ, LLQ
365
Normoactive
5-30 clicks/gurgles in 2 mins
366
Hypoactive
Less than 5 clicks/gurgles in 2 mins
367
Hyperactive
Greater than 30 clicks/gurgle in 2 mins or rumbling.
368
Absent
No clicks/gurgles for at least 5 mins.
369
ADLs
Activities of daily living (toileting, showering, dressing, etc.)
370
Guaiac
A test for blood in the stool, also called hem occult test.
371
Petechiae
Pinpoint, round, red, and purple spots on the skin, like small blood vessels have popped.
372
Sputum
Lung secretions ejected from the mouth.
373
Tinnitus
Ringing in the ears.
374
Vertigo
Dizzy whirling sensation
375
Syncope
Fainting
376
Flatus
Gas passed through the rectum
377
Peristalis
Movement of intestines.
378
Peristalsis
Movement of Intestines
379
Concave
Curving inward, sunken.
380
Convex
Curving outward, bulging.
381
Distended Abdomen
Protruding, taut abdomen.
382
Rigid Abdomen
Firm, board-like on palpation.
383
Striae
Stretch marks
384
Hypertrophy
Overdevelopment
385
Atrophy
Underdevelopment or wasting of muscle tissue.
386
Regression
Reverting back to behaviors once outgrown, like bedwetting.
387
Early Signs and Symptoms of Hypoxia
-Agitation
-Anxiety
-Changes in level of consciousness.
-Headache
-Disorientation
-Irritability
-Restlessness
-Tachypnea
388
Late Signs and Symptoms of Hypoxia
-Bradycardia
-Cardiac Dyshythmias
-Cyanosis
-Decreased Respiratory Rate (Bradypnea)
-Retractions
389
What way of taking temperature is the most accurate?
Rectal
390
Newborn Heart Rate Average
120-160 bpm
391
1-2 Years Old Heart Rate Average
90-120 bpm
392
3-18 Years Old Heart Rate Average
80-100 bpm
393
Adults Heart Rate Average
60-100 bpm
394
Newborns Respirations Average
30-60 Breaths per minute
395
Infants Respirations Average
20-40 Breaths per minute
396
Children Respirations Average
20-30 Breaths per minute
397
Adolescents Respirations Average
14-25 Breaths per minute
398
Adults Respirations Average
12-10 Breaths per minute
399
Normal Blood Pressure Averages
Systolic: Less than 120
Diastolic: Less than 80
400
Elevated Blood Pressure Averages
Systolic: 120-129
Diastolic: Less than 80
401
High BP Stage 1 Averages
Systolic: 130-139
Diastolic: 80-89
402
High Blood Pressure Stage 2 Averages
Systolic: 140 or Higher
Diastolic: 90 or Higher
403
Pale
A lighter color, more white than usual; if not the patients normal "fair coloring", indicates poor circulation.
404
Erythematous
Redness of a designated site, usually a sign of inflammation due to increased circulation to the inflamed site.
405
Flushed
Widespread, diffuse red color of face; possible includes the body; usually cause by fever, embarrassment, exertion or sunburn.
406
Jaundiced
Yellow or orange coloring of the skin and mucous membranes, easily detected in the sclera and palm of the hands; cause by liver impairment.
407
Cyanotic
Bluish-gray color of the skin and mucous membranes due to hypoxia and extreme vasoconstriction.
408
Ecchymotic
Caused by bruising of the skin (ecchymosis); fresh bruises are bluish-purple, and older bruises turn greenish-yellow as they begin to resolve.
409
Bronzing
Bronze pigmentation of the skin due to disorders of iron metabolism; iron pigments are deposited in the body tissues.
410
APETM
Aortic, Pulmonary, Erb's Point, Tricuspid, Mitral
411
PERRLA
Pupil Equal Round and Reactive to Light and Accomodation
412
Neuroleptic Malignant Syndrome
A rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction.
413
Extrapyramidal Symptoms
An inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements.
414
Anticholinergic Syndrome
Drugs that block and inhibit the activity of the neurotransmitter acetylcholine (ACh) at both central and peripheral nervous system synapses.
415
Some medications should be held 48 hours prior to or after a client has IV contrast for testing these are?
Glucophage, Fortament, Riomet, Glumetza, Metformin, Avandament, Glucovance, Metaglip, Actoplus Met, Janumet, Kombiglyze.
