Final Exam: SG Material Flashcards
(92 cards)
1
Q
Can an LVN be delegated to hang an antibiotic piggyback bag?
A
No, can only hang standard fluids (eg: NS, lactated ringers, D5W)
2
Q
A nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of thrush?
A
Superinfection (oral candidiasis)
3
Q
An adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5 C. The nurse will expect the provider to order?
A
An empirical antibiotic (broad-spectrum) while waiting for a sputum culture test result
4
Q
What can occur if one bacteria grows resistant to an antibiotic?
A
Many others will become resistant in a few days
5
Q
The nurse is caring for a patient on a med-surg unit who has a fever of unknown origins. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
A
Obtaining all cultures before the antibiotic is administered
6
Q
A child has received amoxicillin for previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism?
A
Drug inactivation
7
Q
Testosterone
- routes (4)
- class
- use
- patient teaching (2)
A
- buccal, nasal, transdermal, IV
- class: androgen
- use: delayed puberty by age 14
- patient teaching: report weight gain of 5 lbs in a week, assess for edema
8
Q
Aspirin
- class (3)
- side effect
- risk for?
A
- NSAID, antipyretic, antiplatelet
- GI bleed
- risk for bleeding
9
Q
Should patients give themselves insulin if there are formed components in the vial?
A
No
10
Q
Where should insulin be stored?
A
In the refrigerator
11
Q
Patient teaching for subcutaneous lispro insulin injection? (4)
A
- rotate injection sites (eg: quadrants of ABD)
- document sites of injection
- fast and regular acting insulin can be mixed with NPH
- cannot be mixed with long-acting
12
Q
Prednisone
- class
- dosage
- expected effect of medication
- side effect
A
- class: corticosteroid/antiinflammatory
- dosage decreases overtime (eg: first day take 8, then the next day take 7 and so on)
- body should make its own steroids by the end of therapy
- side effect: immunosuppression (higher risk for infection)
13
Q
Lithium
- class
- use
- expect what order from the HCP for this drug?
- side effect
- patient teaching
A
- barbiturate
- use: treat bipolar disorder
- peak and trough (narrow therapeutic index is 0.8-1.2)
- side effect: metallic taste in the mouth
- patient may not experience desired effect for up to 14 days
14
Q
Clomiphene citrate
- use
- action
- side effects (4)
A
- promotes fertility
- action: induces ovulation for a higher chance of birth
- side effects: breast discomfort, dizziness, fatigue, depression
15
Q
Levothyroxine
- for which disease process?
- action
- which age population can possibly misuse drugs?
A
- replacement therapy for hypothyroidism
- increases metabolism
- teenagers (esp females) may take this to lose weight
16
Q
What is hypothyroidism?
A
Decrease in thyroid hormones caused by decreased T4 levels and elevated TSH levels
17
Q
Acetaminophen (tylenol)
- class (2)
- adverse effect
- what s/s to report (5)
- patient teaching? (2)
A
- analgesic, antipyretic
- adverse effect: hepatotoxicity
- jaundice, nausea, vomiting, weight loss, confusion
- taken as PRN only for pain; assess liver function (AST and ALT)
18
Q
Amoxicillin
- class
- group
- action (bactericidal or bacteriostatic)
- patient teaching (5)
A
- broad-spectrum antibiotic
- penicillin
- inhibits cell wall synthesis of bacteria; is BACTERICIDAL (kills bacteria)
- take the full dose
- can decrease the effect of oral contraceptives (may need backup)
- any antibiotic (esp if given through IV) can cause C.diff
- female patients can end up with a yeast infection
- know s/s of allergic reactions
19
Q
Epinephrine
- class
- use
- patient on epi drip or given lots of glucocorticoids must take?
A
- adrenergic agonist
- treat anaphylactic dependent diabetes mellitus
- must take insulin or an oral antibiotic (eg: metformin) because epi can raise blood sugar
20
Q
Mafenide acetate
- class
- use
- nursing intervention
- patient teaching (2)
A
- class: topical antiinfective
- use: treat burns and burn infections
- monitor vitals for signs of hypovolemic shock and infection
- s/s of infection (increased temperature) and hypovolemia (tachycardia and hypotension)
21
Q
Warfarin (coumadin)
- class
- use (2)
- action
- side effects (3)
- monitor for? (2)
- antidote
- patient teaching (2)
A
- anticoagulant
- prevents PE, DVT
- works on the coagulation cascade
- GI bleed, nausea, ABD cramps
- INR and PT
- Vitamin K
- At risk for bleeding: consult a dentist when taking medication, use soft toothbrush, shave with an electric razor; takes 3-4 days to affect the patient!!
22
Q
Normal for INR and PT when on warfarin? When should INR be taken and when should it be held?
A
- INR: 2-3
- PT: 10-13 seconds
- INR is taken before administration
- Hold if INR is >3
23
Q
Albuterol
- class
- route
- patient teaching
A
- bronchodilator / short-acting-beta-adrenergic agonist (SABA)
- metered-dose inhaler
- only used for PRN in an asthma attack or emergency
24
Q
Long-acting beta-adrenergic agonists (LABA) must be taken with?
A
glucocorticoids
25
Metformin
- class
- can a patient go into hypoglycemic shock with this alone?
- action
- biguanide
- patient cannot go into hypoglycemic shock (first choice antidiabetic drug)
- tells liver to decrease glucose production
26
Nitroglycerin
- class
- routes (4); which has the most absorption
- use
- adverse effect
- vasodilator
- oral, transdermal, IV, sublingual (has the most absorption)
- stable angina (not effective for unstable)
- hypotension
27
Patient teaching for nitroglycerin (4)
- take while sitting or lying down (orthostatic hypotension)
- dissolve under the tongue, do not swallow or chew
- take a max of 3 doses, one every 5 mins; if pain is not relieved call 911
- ROTATE sites when transdermal patches are used
28
Sulfonamide TMP-SMZ
- class
- routes (2)
- use
- this drug has a high ____
- penicillin / combination sulfa drug
- oral (used for systemic infections) and topical
- uncomplicated UTIs (that has not spread or caused systemic infection)
- resistance (comes from the first group of antibiotics)
29
Valsartan
- class
- action
- use
- for female patients, assess if they are ____
- contraindicated with which medication?
- angiotensin receptor blocker
- blocks action angiotensin II causing vasodilation
- HF and HTN
- pregnant (fetal toxic)
- ACE inhibitors
30
Cephalosporin
- class
- which generation of antibiotics is this drug?
- use
- allergy concern?
- antibiotic
- 1st gen = high resistance
- prophylactically for long-term hospital stay or surgery (eg: in the OR for long-term surgery)
- if the patient is allergic to penicillin, they are allergic to a cephalosporin (similar chemical structure)
31
Out of the 5 generations of antibiotics, which has the highest resistance and which has the lowest? Which generations are used prophylactically?
1st gen has more resistance and is used prophylactically for broad-spectrum bacteria
5th gen has the least
32
Benadryl (diphenhydramine)
- class
- use (3)
- side effects (3)
- patient should avoid taking?
- for motion sickness, when should the patient take this?
- patient teaching for which specific side effect?
- H1 receptor antagonist
- allergies (seasonal), motion sickness, insomnia
- high risk for falls (esp in older adults), sedative, anticholinergic side effects (dry mouth, blurred vision, urinary retention)
- alcohol and CNS depressants (can further depress the CNS)
- take 30 mins-1 hr BEFORE
- drowsiness
33
The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that the patient has not voided for 12 hrs. What action will the nurse take?
Evaluate the bladder to check for distension
34
Patients with seasonal allergies with runny nose during the daytime report increasing nighttime symptoms that are interfering with sleep. The provider recommended diphenhydramine. What info will the nurse include when teaching the patient about this medication?
"You should be able to sleep better when you take this medication"
35
Parents of a 3 yr old child tell the nurse that they are planning to give their child diphenhydramine on a flight. What will the nurse tell the patients about giving this drug?
Diphenhydramine may have the opposite effect and could cause agitation
36
Alprazolam
- class
- what disease process requires us to give an IV of a benzodiazepine?
- benzodiazepines
| - status epilepticus (seizure that cannot stop)
37
Promethazine HCL (Phenergen)
- class
- use
- when would be the ideal time to give this medication to a patient who has chemotherapy?
- contraindicated in which patients (2)
- antiemetic
- used for nausea and vomiting after surgery or chemotherapy
- 1 hour before nausea and vomiting
- patients with glaucoma or pregnant
38
Phenytoin (Dilantin)
- class
- what would you expect the HCP to order for this medication?
- anti-seizure
| - peak and trough (narrow therapeutic index of 10-20)
39
A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode after arriving. The patient has been taking phenytoin 100 mg 3 times daily and oxcarbazepine 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL and the oxcarbazepine is 22 mcg/mL. The nurse contacts the HCP to report the levels. What will the nurse expect the HCP to order?
An increased dose of phenytoin (8.6 is less than narrow therapeutic index of 10-20)
40
A patient who is beginning to take phenytoin for epilepsy, which statement by the patient indicates an understanding of the teaching? (3)
- narrow therapeutic index
- avoid alcohol
- for female patients, this drug is teratogenic
41
Before administering antibiotics, what should be done first?
Blood draw to identify the culture (unless the patient is very sick)
42
What should be expected to order by the HCP for an unidentified bacterial infection?
broad-spectrum antibiotic
43
The nurse will monitor the patient taking albuterol for which conditions? (3)
- palpitations
- hypertension
- bronchospasm
44
A patient who is taking epinephrine is also taking several other medications. The nurse should realize that there is a possible drug interaction with which drugs? (3)
- metoprolol
- propranolol
- digoxin
45
A patient is given epinephrine, an adrenergic agonist. The nurse should monitor the patient for which condition?
Increased BP
46
A patient is taking levothyroxine. For which adverse effect would the nurse monitor?
Tachycardia
47
A patient arrives in the ED after developing a rash, runny nose, and sneezing after eating strawberries. What action will the nurse take first?
Assess HR, resp rate, and lung sounds
48
A nursing student asks why the anticoagulant heparin is given to patients who have disseminated intravascular coagulation and are at risk for excessive bleeding. The nurse will explain that heparin is used in this case for which reason?
To decrease the risk for venous thrombosis
49
A patient has been receiving IV heparin. When the labs are drawn, the nurse has difficulty stopping the bleeding at the puncture site. The patient has bloody stools and reported ABD pain. The nurse notes elevated PTT time and apTT. Which action will the nurse perform?
Obtain an order for protamine sulfate
50
A nurse is caring for a patient who is receiving warfarin (coumadin) and notes bruising and petechiae on the patient's extremities. The nurse will request an order for which lab test?
INR (international normalized ratio)
51
A patient who is taking warfarin has an INR of 5.5. The nurse will anticipate giving?
Oral vitamin K
52
The nurse is caring for a post-op patient who is receiving alteplase after developing a blood clot. The nurse notes an HR of 110 bpm and a BP of 90/60. The nurse will perform which action?
Assess the surgical dressing for bleeding
53
Calcitriol
- class
- use (3)
- nursing consideration
- patient teaching: s/s of hypocalcemia (3); hypercalcemia (4)
- vitamin D supplement
- treat hyperparathyroidism, hypoparathyroidism, hypocalcemia in chronic renal failure
- monitor serum calcium level (8-10 mg/dL)
- patient teaching: s/s of hypocalcemia (twitching of mouth, paresthesia of fingers, tetany); hypercalcemia (bone pain, nausea, vomiting, thirst)
54
A patient has just begun taking calcitriol. Which nursing implication would the nurse do?
Monitor serum calcium levels
55
Ibuprofen
- class
- use (2)
- side effects
- before?
- after admin?
- NSAID
- mild to moderate pain, lower fever
- GI bleed/distress
- before: acute pain and inflammation
- after: pain level decreased swelling/redness reduced
56
All NSAIDs are toxic to which organ? Tylenol is toxic to which organ?
NSAIDs: kidneys and causes GI distress
Tylenol: liver
57
Sucralfate
- class
- use (2)
- action
- patient teaching
- antiulcer pepsin inhibitor
- use: prevents injury from drug-induced ulcers (eg: aspirin, NSAIDs); prevents duodenal ulcers
- action: provides protective covering on ulcer surface
- take 1 hour before meals and at bedtime
58
Esomeprazole
- class
- use
- proton pump inhibitor
| - GERD
59
Aluminum hydroxide
- class
- use
- action
- side effect
- patient teaching (2)
- antacid
- treats hyperacidity
- neutralizes gastric acidity (does not get rid of acid)
- constipation
- should be taken AFTER meals when acid is high in stomach and should not be taken with other PO medications
60
A patient who has been instructed to use liquid antacid to treat GI upset asks the nurse about how to take this medication. What info will the nurse include when teaching this patient?
Take 60 mins after meals and at bedtime
61
Alteplase
- class
- route
- use (5)
- action
- thrombolytic (clot buster)
- IV
- ischemic stroke, a clogged artery in heart, thromboembolism, PE, DVT
- active clot breakdown in the lungs, heart, and brain
62
Nursing interventions for alteplase? (3)
- assess if patient had a thrombolytic in the last 2-3 weeks
- head-to-toe assessment for cuts, bleeding, orifices that patient can bleed from
- stay with patient for initial 30 mins after admin to make sure patient does not bleed out
63
If a patient has had an ischemic stroke (blockage in the artery of the brain), how many hours after they've had the onset of the stroke are open to taking the thrombolytic?
3-5 hours
64
When should alteplase NOT be given?
If the patient had a thrombolytic stroke in the last 5-7 days
65
What is the main concern for alteplase?
Bleeding and hemorrhage risk
66
Contraindications in alteplase administration (2)
- severe HTN
| - Concurrent use with NSAIDs/aspirin (high risk for bleeding)
67
Patient teaching for alteplase? (4)
- take tylenol for pain instead of NSAIDs or aspirin
- keep surroundings clean and cover sharp edges
- fall risk: remove loose carpeting
- s/s of internal bleeding that indicates too much anticoagulant: bleeding, purpura, bruising, dark/tarry stool
68
Spironolactone
- class
- where does it work?
- how much diuresis does it produce?
- potassium-sparing diuretic
- collecting ducts of kidneys
- produces least amount of diuresis
69
What if the patient is on spironolactone and ACE inhibitors?
Can raise potassium levels too high (may have to hold ACE inhibitor)
70
A patient has begun taking spironolactone in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to report?
Decreased urine output to the HCP
71
A patient has been taking spironolactone to treat HF. The nurse will monitor for?
Hyperkalemia
72
Clopidogrel bisulfate (Plavix)
- class
- action (2)
- use (4)
- not a first choice for patients with _____
- antiplatelet
- decreases platelet aggregation; prolongs bleed time
- prevents thrombosis, MI, stroke, ischemic stroke attack
- active pulmonary embolism (last choice of treatment)
73
Bisacodyl
- class
- routes (2)
- use
- can lead to ____
- laxative
- PO and rectal
- constipation
- fast acting but can lead to dependence
74
A patient who has constipation is prescribed a bisacodyl suppository. Which explanation will the nurse use to explain the action of bisacodyl?
Acts on the smooth intestinal muscle to gently increase peristalsis
75
Psyllium
- class
- use
- action
- patient teaching
- bulk-forming laxative
- constipation
- draws water into the intestine
- should be taken immediately after mixing with water
76
Montelukast
- class
- use
- patient teaching (4)
- leukotriene receptor antagonist / bronchodilator
- maintenance drug for asthma and COPD
- teach patient that it is for maintenance only
- should not be used in an emergency asthma attack
- assess liver function labs in the EVENING
- NSAIDs should not be taken with montelukast
77
Atorvastatin
- class
- action
- manage hyperlipidemia
| - lowers LDL levels
78
Patient teaching for atorvastatin (5)
- avoid grapefruit
- take with water or food to help with GI effects
- takes 6-8 wks for onset
- requires lifelong therapy (encourage adherence)
- report: muscle weakness/tenderness, darkened urine (s/s of rhabdomyolysis/muscle breakdown)
79
A patient has been taking atorvastatin for several months to treat hyperlipidemia. The patient reports severe muscle weakness and tenderness. The nurse will counsel the patient to do which of the following?
Report symptoms to the HCP
80
Digoxin
- class
- use
- positive inotrope: ___
- has both __ and __ qualities
- nursing intervention
- derived from ____
- cardiac glycoside
- HF
- increases contractility, slows HR
- ionotropic and chronotropic
- assess apical pulse for a full minute before, hold if less than 60
- foxglove plant
81
A patient has congestive HF and has been taking digoxin for 9 years. The patient is admitted with s/s of digoxin toxicity. Which s/s are associated with digoxin toxicity? (3)
- vomiting
- yellow halos in the visual field
- diarrhea
82
The nurse is preparing to administer digoxin to a patient that has HF. The patient reports nausea, vomiting, and a headache. The nurse notes a resp rate of 18, HR of 58, and a BP of 120/78. What will the nurse do next?
Hold the dose and notify the HCP of a possible digoxin toxicity
83
The nurse administers a dose of digoxin to a patient who has HF and returns to the room later to reassess the patient. Which finding indicates that the medication is effective?
Decreased dyspnea
84
Doxycyline
- class
- action
- patient teaching (2)
- antibacterial tetracycline
- action: bacteriostatic and bactericidal
- tooth and nail discoloration is expected
- risk for aspiration (dysphagia is a side effect)
85
Metoprolol
- class
- use (4)
- patient teaching (2)
- expected outcome?
- beta-blocker / antihypertensive
- HTN, angina, HF, acute MI
- encourage adherence to drug regimen; abrupt discontinuation may cause rebound HTN
- check with HCP before taking OTC drugs
- expected to see decrease in BP (120/80 or below)
86
A patient is prescribed metoprolol for HTN. It is important for the nurse to monitor the patient for which condition? (2)
Bradycardia, hypotension
87
Carbidopa/levodopa
- class
- use (2)
- carbidopa role?
- side effect
- patient teaching (3)
- benztropine
- treats Parkinson's disease and involuntary shaking
- carbidopa helps levodopa for a longer duration
- side effect: insomnia
- rise slowly to reduce the risk for falls (orthostatic hypotension)
- do not discontinue abruptly; rebound PD can occur
- food may decrease GI upset
88
What might be a reason why a patient stops taking benztropine?
Patients with glaucoma due to anticholinergic side effects (blurred vision, dry mouth, urinary retention)
89
A patient with stable COPD has prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?
A long-acting beta2 agonist (LABA) inhaler
90
A patient with asthma comes to a clinic for treatment of an acute exacerbation. The patient's medication hx lists an inhaled glucocorticoid, montelukast, and a SABA as needed via MDI. The nurse assesses the patient and notes a resp rate of 18, HR of 96, O2 sat of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilateral. What will the nurse do?
Question the patient about how much albuterol has been used
91
What is a universal adverse effect that would require patients to seek medical attention?
Anaphylaxis or hypersensitivity to a drug
92
What common side effect of ACE inhibitors can cause a patient to become non-adherent to the drug?
"ACE cough" (non-productive and can be irritating to patient)
