Flashcards in Learn Smart Pharmacology 1 Deck (36)
Teaching parents of a child w/ Rx for valproic acid (Depakene) for seizures. Child must return to clinic in 2 wks for WOTF tests? (MM)
b. platelet count
c. Aspartate aminotransferase (AST)
e. Alanine aminotransferase (ALT)
b, c and e. A major SE of valproic acid is on the hematologic system, causing thrombocytopenia and prolonged bleeding time. The drug can also cause severe hepatotoxicity especially in young children. Thus AST and ALT (identifies liver damage) must be monitored closely during the 1st few months of therapy.
RN caring for p receiving heparin for DVT prophylaxis. RN correctly delivers the heparin by?
a. using the SC sites in the abdomen
b. administering the injection using the z-track method into the thigh
c. massaging the injection site after injection
d. administering the injection with a 22 gauge needle
A. heparin is injected into the fatty layers of the abdomen. It is not injected into thigh muscles, and it should be given with a 25 gauge or smaller needle to decrease the risk for hemorrhage. Massaging the site afterwards can also increase hemorrhage risk. Apply gentle pressure only.
RN should anticipate giving wotf meds for a p who is scheduled to have contraction stress test (CST)?
a. oxytocin (Pitocin)
b. Nifedipine (Procardia)
c. Betamethasone (Celestone)
d. Rho (D) immune globulin (RhoGAM)
a. Oxytocin is administered to stimulate contractions during a CST. Nifedipine is a tocolytic med that is given to stop UCs in preterm labor. Betamethasone is given in the intrapartum period to promote lung dvlpmt if early delivery is expected. RhoGAM is given in the antepartum period to Rh-negative mothers to prevent hemolytic disease of the NB.
RN caring for p w/ PUD. WOTF meds should be given to alleviate a h-ache?
a. ibuprofen (Advil)
b. Naproxen (Naprosyn)
c. Aspirin (Ecotrin)
d. Acetaminophin (Tylenol)
d. Acetaminophen is an analgesic used for mild to moderate pain. It is appropriate for p's with PUD bc it doesn't affect blood coagulation or increase the risk for GI bleeding. Ibuprofen and Naproxen are both NSAIDs, which are CI'd for p's w/ PUD or active bleeding disorders due to the increased risk of GI blds. Aspirin is also CI'd bc of the risk of GI irritation and hemorrhage.
RN is caring for a p who is receiving heparin IV therapy. The morning aPTT is 90 seconds (control of 26). RN should FIRST?
a. administer protamine sulfate
b. turn off the infusion
c. contact the primary HCP
d. request a repeat blood test
b. turn of the infusion. An aPTT of 90 seconds is 1.5-2 times the normal value. The greatest risk to the p is hemorrhage so the RN should turn off the infusion to prevent giving any more heparin. C and D are necessary but should not be done first. A may be necessary to reverse the effects of heparin but it is not the first action
Rn should know that metoclopramide (Reglan) is CI'd for a p who?
a. is receiving chemo
b. has an intestinal obstruction
c. has glaucoma
d. is vomiting after a colon resection
b. Reglan promotes gastric emptying so it shouldn't be given to a p with a bowel obstruction. Reglan is used to tx vomiting r/t chemotherapy and to control postop vomiting. Reglan is not CI'd in p's w/ glaucoma
After taking erythromycin PO for 7 days, a p develops oral candidiasis. RN recognizes that this is most likely r/t wotf?
a. allergic response
c. synergistic rxn
d. erythromycin toxicity
b. superinfection. The candid fungus is normally present in the mouth. The antibiotic effect of erythromycin allows the fungus to grow out of control which results in a superinfection. Candidiasis is not an allergic or synergistic response. Erythromycin toxicity is manifested by hearing loss (ototoxicity) and hepatotoxicity
A p w/cirrhosis is Rx'd lactulose (Cephulac) PO. For wotf actions should the RN administer lactulose?
a. to increase BP
b. to prevent bleeding from esophageal varices
c. to decrease HR
d. to reduce serum ammonia levels
d. Cephulac is a laxative that is given to promote the excretion of ammonia. Ammonia levels are increased in lever failure, producing hepatic encephalopathy or coma. Lactulose discourages the growth of bacteria, traps ammonia in the gut, and expels ammonia from the colon. It has no effect on BP/HR/bleeding
P. is Rxd ergotamine tartrate (Ergomar). RN should recognize that ergotamine tartrate is indicated for?
b. migraine headaches
c. ulcerative colitis
b. migraine headaches- ergotamine tartrate blocks alpha-adrenergic receptors in the cranial peripheral vascular smooth muscle to cause vasoconstriction of dilated cerebral blood vessels. Ergotamine tartrate causes vasoconstriction, thus it is CI'd for p's with HTN. It is also CI'd w/ anemia.
RN is reviewing the morning CBC and diff. for a p taking filgrastim (Neupogen). In evaluating the p's response to filgrastim, the RN should review the?
a. erythrocyte count
b. neutrophil count
c. lymphocyte count
d. thrombocyte count
b. neutrophil count - Filgrastim is used to raise the absolute neutrophil count (it stimulates proliferation of neutrophils) in p's who have neutropenia r/t chemo or any other cause. It has no effect on RBCs, lymphocytes or platelets
RN caring for p Rxd amphotericin B (Fungizone). WOTF should the RN recognize as the best indicator of renal function?
a. serum K+
b. daily wts
d. Serum creatinine levels
d. Creatinine levels are the most accurate indicator of renal function. The levels should be monitored q-other-day as the dosage of amphotericin B is increased to optimal level and then weekly until the drug is d/c'd. If creatinine increases to 3 mg/mL, the dose should be decreased or d/c's until renal function improves. Amphotericin is an antifungal drug that binds to sterols in fungal cell membranes.
Older adult p w/ depression is Rx'd the TCA amitriptyline (Elavil). WOTF dx tests will be ordered prior to starting this med?
b. EEG (electroencephalogram)
d. liver function profile
c. ECG - older adults have an increased risk for experiencing CV SEs of amitriptyline. Thus, an ECG will show baseline cardiac functioning. Amitriptyline does not cause liver dysfunction or hematologic changes. It does not pose any risk for seizures
Teaching to parents of child who is Rx'd cromolyn sodium (Intal) via metered dose inhaler. WOTF ind need for further teaching?
a. I will give my child a dose as soon as wheezing starts
b. my child needs to do a mouth rinse after using the inhaler.
c. my child should breathe in slowly while depressing the canister
d. if my child has difficulty breathing in the dose, a spacer should be used.
a. Cromolyn sodium is a mast cell inhibitor that has a very slow onset and is used only prophylactically. It is not a rescue medicine for acute asthma attacks. Rinsing the mouth after helps alleviate mouth/throat irritation c/b Intal. Breathing in slowly while depressing the canister is the correct way to use a MDI. A spacer allows p's to receive inhalation medication in subsequent breaths
RN ax-ing p taking tamoxifen (Nolvadex). RN should recognize that tamoxifen is an?
b. anti-estrogenic. Tamoxifen is used to tx breast CA in both pre- and post- menopausal women. It has been shown to delay recurrences also. Tamoxifen has no antimicrobial or anti-infla effect. It is not androgenic, androgens are the male hormones used to tx breast CA
While providing teaching to a p Rx'd hydrochlorothiazide (Oretic) for HTN, the RN should tell the p to take the medication:
a. when edema is present
b. at bedtime
c. on an empty stomach
d. in the am
d. in the am - taking diuretics in the morning allows for diuresis during the day without interfering with sleep. The drug should be taken on a regular basis (qday), not prn, and should be taken with food to minimize GI disturbances.
When giving diphenoxylate and atropine (Lomotil) to a p with ulcerative colitis, the RN should mon for?
a. Toxic megacolon
b. pseudomembranous colitis
c. increased bleeding time
d. drug addiction
a. Toxic megacolon- ps w/ UC are at risk for developing toxic megacolon, a condition characterized by paralysis of colonic peristalsis resulting in rapid dilatation of the bowel. S&S include: tachy-c, hypotension, fever, abd cramps, and a cessation of diarrhea. Lomotil is CI'd for p's with pseudomembranous colitis. Drug addiction is very unlikely bc higher doses yield SEs of atropine
When preparing d/c plan for a p on long-tm prednisone (deltasone) therapy, the RN should be aware that the p is at risk for?
a. gingival ulcerations
b. orthostatic hypotension
c. stress fxs
d. wt loss
c. stress fractures - corticosteroids (synthetic glucocorticoids) cause demineralization of bones and leads to osteoporosis and stress fxs. P's are not at risk for gingival ulcerations. P's are at risk for HTN (not ortho hypo) r/t sodium and fluid retention, as well as weight gain (not loss)
While teaching a p w/ a new Rx for allopurinol (zyloprim), the RN should tell the p to d/c the medication if wotf occurs?
b. metallic taste
c. fever. Allopurinol is a xanthine oxidase inhibitor used to tx gout. Inhibition of xanthine oxidase leads to decreased uric acid production; thus, decreasing the concentrations in serum and urine. Nausea, metallic taste, and drowsiness are all expected SEs. Fever, joint pain, and pruritic maculopapular rashes all indicate a potentially fatal toxic/allergic rxn
P. teaching for gemfibrozil (Lopid) is effective if p. states he will have wotf evaluated periodically?
a. platelet counts
b. serum electrolyte levels
c. thyroid function tests
d. Gemfibrozil is converted by the liver to active metabolites that decrease hepatic uptake of free fatty acids, lowering serum cholesterol and LDL levels. It is CI'd with hepatic dysfunction and LFTs must be monitored for developing liver diseases or elevated transaminase levels.
P. with gestational HTN is started on Mag sulfate IV. WOTF is the priority axmt finding?
a. BP 134/82
b. UOP 45mL/hr
c. DTRs +2
d. Resps 10/min
d. Resps 10/min. Magnesium can depress DTRs as well as the respiratory system. A resp rate less than 12 places the p at risk for inadequate oxygenation.
While taking a medication hx for a p with a new Rx for ceftriaxone (Rocephin), the RN should report wotf allergies to the HCP?
a. Gentamicin sulfate (Garamycin)
b. clindamycin (Cleocin)
c. Piperacillin sodium
d. Sulfamethoxazole-trimethoprim (Bactrim)
c. Piperacillin Sodium. P's with an allergy to a penicillin drug may have cross sensitivity to Ceftriaxone, which is a third generation cephalosporin. Gentamicin sulfate is a bactericidal aminoglycoside. Clindamycin is a Lincosamide antibiotic (bacteriostatic) used to tx acne. Bactrim is a sulfonamide antibiotic.
When giving the first dose of enalapril maleate (Vasotec), wotf is the priority axmt?
b. Resp rate
c. BP - when taking the first dose of enalapril the greatest risk to the p is orthostatic hypotension. The others options should be assessed as well, but they are not the priority
P. to receive 1 L of Lactated Ringers IV over 8 hr. The drip factor on the IV tubing is 10gtt/mL. What rate should the nurse set the IV to deliver the fluid as prescribed?
1L/8hr = 125mL/hr.
(125 mL/hr x 10 gtt/mL)/ 60 minutes = 20.83 = 21 gtt/min
Rn is reviewing the admission Rxs for a p who has just been admitted from the ER w/ a Rx for clopidogrel (Plavix). WOTF precautions should the RN plan?
b. bleeding precautions - Plavix is an antithrombotic and antiplatelet aggregate agent used to lessen the chance of MI or CVA. Bleeding precautions attempt to limit p exposure to injury causing events that may lead to internal or external bleeding. There is no indication for neutropenic precautions which are used for ps at risk for infection, or for airborne/contact precautions
Older p is Rxd zolpidem (Ambien) at HS to help promote sleep. The RN should plan to mon the p for wotf?
b. decreased UOP
c. Increased BP
d. Confusion - older ps taking ambien are at risk for confusion (decreased LOC). Zolpidem does not affect bld coagulation, urine output, or BP.
P is Rxd chlorpromazine hydrochloride (Thorazine) and is experiencing extreme restlessness and involuntary movements. WOTF should the RN give to tx these SEs?
a. Amantadine (Symmetrel)
b. Bupropion (Wellbutrin)
c. Phenelzine (Nardil)
d. Hydroxyzine (Atarax)
a. Amantadine (Symmetrel) is an antiparkinsonian drug used to tx extrapyramidal side effects, such as extreme restlessness and involuntary movements that result from typical antipsychotic medications, like Chlorpromazine hydrochloride. Bupropion is an atypical antidepressant, Phenelzine is a MAOI antidepressant, and hydroxyzine is an antihistamine used to tx mild to moderate anxiety states.
P. is being txd w/ a 10 day course of gentamicin sulfate (Garamycin). WOTF findings indicate an AE?
c. elevated temperature
d. visual disturbance
b. proteinuria. Gentamicin sulfate is an aminoglycoside antibiotic that can be nephrotoxic, as well as irreversibly ototoxic. Risk increases with high doses and prolonged therapy.
P has been taking isoniazid (INH) and rifampin (Rifadin) for 2 wks after being dxd with active TB. P calls the clinic c/o red/orange urine. RN response?
a. Stop taking the INH for 2-3 days and it will go away
b. Rifampin may turn all body fluids orange-red. This is a harmless SE
c. Ill make an apptmt for you to see the doctor this afternoon.
d. these meds are known to cause bladder irritation when taken together
b. Rifampin will turn body fluids (tears, sweat, saliva, and urine) an orange-red color, it is harmless. TB P's should not be told to stop taking the medications unless the Rxs change. These drugs are not irritating to the bladder.
P. had an acute MI and is taking chlorothiazide (Diuril) 500 mg and Digoxin (Lanoxin) 0.25 mg daily. RN should plan to mon for?
a. elevated temperature
b. hyperactive reflexes
c. muscle weakness
d. weight loss
c. muscle weakness. The patient is at risk for hypokalemia due to fluid loss from the non-K+ sparing diuretic, which places him at a greater risk for digoxin toxicity. Muscle weakness is a sign of hypokalemia. P's taking both of these medications are often Rx'd a K+ supplement as well. Hypokalemia can also result in hypoactive reflexes (not hyperactive). There is no indication to mon 4 fever, or wt loss