Med Pass Exam

Question 1

What is the purpose of aspirin administration?

Answer 1

Treat: Mild to moderate pain like rheumatoid arthritis, osteoarthritis, thromboembolic disorders, transient ischemic attacks, post-MI, prophylaxis of MI, ischemic stroke, angina; acute MI, Kawasaki disease and treat mild to moderate fever like rheumatic fever.

Question 2

What are the precautions of aspirin med?

Answer 2

Abrupt discontinuation
acetaminophen/NSAIDs hypersensitivity
acid/base imbalance
alcoholism
ascites
asthma
bone marrow suppression, geriatric patients, dehydration, G6PD deficiency, gout, heart failure, anemia, renal/hepatic disease, pre/postoperatively,
gastritis
pregnancy C 1st trimester

Question 3

Administration of aspirin med?

Answer 3

Demonstration
PO route:
• Do not break, crush, or chew enteric product
• Administer to patient crushed or whole (regular PO product); chewable tab should be chewed
• Give with food or milk to decrease gastric symptoms; separate by 2 hr of enteric product; absorption may be slowed
• Give antacids 1-2 hr after enteric products
• Give with 8 oz of water and have patient sit upright for 30 min after dose; discard tabs if vinegar-like smell is present; avoid if allergic to tartrazine

Question 4

Side effects of aspirin?

Answer 4

Constipation
abdominal cramping/upset
headache, heartburn, indigestion, light-colored stool

Question 5

Adverse effects of aspirin?

Answer 5

GI bleeding
hepatoxicity
hemolytic anemia
Reye’s syndrome (children), anaphylaxis, laryngeal edema, angioedema

Question 6

Mode of action of aspirin?

Answer 6

 Blocks pain impulses by blocking COX-1 in CNS = reduces inflammation by inhibition of prostaglandin synthesis
 Antipyretic action results from vasodilatation of peripheral vessels
 decreases platelet aggregation

Question 7

Nursing assessment of aspirin?

Answer 7

Assess for hepatotoxicity: dark urine, clay-colored stools, yellowing of the skin and sclera, itching, abdominal pain, fever, diarrhea if patient is on long-term therapy
Assess for allergic reactions: rash, urticaria; if these occur, product may have to be discontinued; in patients with asthma, nasal polyps, allergies, severe allergic reactions may occur
Assess for ototoxicity: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
Monitor salicylate level: therapeutic level 150-300 mcg/ml for chronic inflammation
Beers: Avoid chronic use in older adults, GI bleeding may occur
Assess for pain: character, location, intensity, ROM before and 1 hr after administration

Therapeutic outcome: Decreased pain, inflammation, fever; absence of MI, transient ischemic attacks, thrombosis

Question 8

Functional class and chemical class of aspirin?

Answer 8

Functional class: Nonopioid analgesics
Chemical class: salicylate

Question 9

Purpose of atorvastatin med?

Answer 9

 As an adjunct in primary hypercholesterolemia (types Ia, Ib), dysbetalipoproteinemia, elevated triglyceride levels
 Prevention of cardiovascular disease by reduction of heart risk in those with mildly elevated cholesterol

Question 10

Precaution of atorvastatin

Answer 10

Past liver disease, alcoholism
severe acute infections, trauma, severe metabolic disorders
electrolyte imbalance

Question 11

Side effects of atorvastatin?

Answer 11

• Headache
• hoarseness
• lower back or side pain
• pain or tenderness around the eyes and cheekbones
• painful or difficult urination
• stuffy or runny nose

Question 12

Adverse effects of atorvastatin?

Answer 12

liver dysfunction, pancreatitis, rhabdomyolysis

Question 13

Mode of actions of atorvastatin

Answer 13

Inhibits HMG-CoA reductase enzyme = which reduces cholesterol synthesis
[high doses lead to plaque regression]

Question 14

Nursing assessment of atorvastatin?

Answer 14

Hypercholesterolemia: assess nutrition: fat, protein, carbohydrates; nutritional analysis should be completed by dietitian before treatment. Monitor triglycerides, cholesterol at baseline and throughout treatment.
Rhabdomyolysis: Assess for muscle pain, tenderness, obtain CPK baseline, if markedly increased, product may need to be discontinued, many drug interactions make the possibility of rhabdomyolysis greater
Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected, do not breastfeed or use in pregnancy
Monitor ALT, AST for liver function
Monitor amylase and lipase for pancreas function

Therapeutic outcome: Decreased cholesterol levels and LDLs, increased HDLs

Question 15

Functional class and chemical class of atorvastatin?

Answer 15

Functional class: antilipidemic
Chemical class: HMG-CoA reductase inhibitor

Question 16

Functional and chemical class of lisinopril?

Answer 16

Functional class: Antihypertensive, angiotensin converting enzyme (ACE) I inhibitor

Chem. class.: Enalaprilat lysine analog

Question 17

Purpose of lisinopril?

Answer 17

Mild to moderate hypertension, adjunctive therapy of systolic HF, acute MI

Question 18

Precautions of lisinopril?

Answer 18

Pregnancy (1st trimester), breastfeeding, renal disease, hyperkalemia, renal artery stenosis, HF, aortic stenosis

Question 19

Side effects of lisinopril?

Answer 19

A dry, tickly cough that does not get better
Feeling dizzy or lightheaded, especially when you stand up or sit up quickly
Headaches
Being sick (vomiting)
Diarrhea
Itching or a mild skin rash
Blurred vision

Question 20

Adverse effects of lisinopril?

Answer 20

Stroke, hepatic failure, hepatic necrosis, pancreatitis, Proteinuria, renal insufficiency, neutropenia, agranulocytosis

Question 21

Mode of action of lisinopril?

Answer 21

Selectively suppresses renin-angiotensin-aldosterone system = inhibits ACE = prevents conversion of angiotensin I to angiotensin II

Question 22

Nursing assessment of lisinopril?

Answer 22

Hypertension: monitor B/P, check for orthostatic hypotension, syncope; if changes occur, dosage change may be required
Acute MI: can be used in combination with salicylates, beta blockers, thrombolytics
HF: check for edema in feet, legs daily, weight daily, dyspnea, wet crackles
Assess blood studies: platelets, WBC with differential: baseline, q3mo; if neutrophils are < 1000/mm3 , discontinue treatment
Assess for anaphylaxis, toxic epidermal necrolysis, angioedema, allergic reactions: rash, fever, pruritus, urticaria; facial swelling, dyspnea, tongue swelling (rare), have emergency equipment nearby, may be more common in Black patients; product should be discontinued if antihistamines fail to help
Monitor renal/liver function tests baseline and periodically: protein, BUN, creatinine; watch for increased levels that may indicate nephrotic syndrome and renal failure; monitor renal symptoms: polyuria, oliguria, frequency, dysuria
Positive therapeutic outcome
• Stable and improved serum glucose, A1C, weight loss

Question 23

Functional and chemical class of diphenhydramine?

Answer 23

Functional class: Antihistamine (1st generation, nonselective), antitussive
Chem. class.: Ethanolamine derivative, H1 -receptor antagonist

Question 24

Purpose of diphenhydramine?

Answer 24

Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, nighttime sedation, infant colic, nonproductive cough, insomnia in children, dystonic reactions

Question 25

Precautions of *diphenhydramine*?

Answer 25

Pregnancy, breastfeeding, children < 6 yr, increased intraocular pressure, renal/cardiac disease, hypertension, bronchial asthma, seizure disorder, stenosed peptic ulcers, hyperthyroidism, prostatic hypertrophy, bladder neck obstruction • Avoid use in children under 6 yr, death has occurred; overdose has occurred in topical gel taken orally (adult/child) • Give 20 min before bedtime if using for sleep aid

Question 26

Administration of *diphenhydramine*?

Answer 26

Demonstration PO • Give with meals if GI symptoms occur; absorption rate may be slightly decreased; cap may be opened and product mixed with food/fluids for patients with swallowing difficulties

Question 27

Side effects of *diphenhydramine*?

Answer 27

*dry mouth, nose, and throat* *drowsiness* *dizziness* *nausea* vomiting loss of appetite constipation increased chest congestion *headache* *muscle weakness* excitement (especially in children) nervousness

Question 28

Adverse effect of *diphenhydramine*?

Answer 28

Seizure, headache, Thrombocytopenia, agranulocytosis, hemolytic anemia, anaphylaxis

Question 29

Mode of action of *diphenhydramine*?

Answer 29

Acts on blood vessels, GI, respiratory system by competing with histamine for H1 -receptor site; decreases allergic response by blocking histamine

Question 30

Nursing assessment for *diphenhydramine*?

Answer 30

*Assess respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness; provide fluids to 2 L/day to decrease secretion thickness* Monitor I&O ratio: be alert for urinary retention, frequency, dysuria, especially geriatric; product should be discontinued if these occur Monitor CBC during long-term therapy; blood dyscrasias may occur but are rare EPS: If giving for dystonic reactions, assess type of involuntary movements and evaluate response to this medication *Cough: Assess characteristics including type, frequency, thickness of secretions; evaluate response to this medication, increase fluids to 2 L/day unless contraindicated* *Anaphylaxis: Assess for rash, throat tightness, have emergency equipment nearby* Therapeutic outcome: Absence of allergy symptoms and rhinitis, decreased dystonic symptoms, absence of motion sickness, absence of cough, ability to sleep

Question 31

Functional class of *ibuprofen*?

Answer 31

NSAID: Non-steroidal anti-inflammation drug

Question 32

Max of ibuprofen given per day? And how many hours apart?

Answer 32

Adult/adolescent: PO (OTC product) 200 mg q4-6hr, may increase to 400 mg q4-6hr; max 1200 mg/day for self-treatment of minor aches/pains Though it can go up to 3200 mg/day max

Question 33

Purpose of *ibuprofen*?

Answer 33

Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, dental pain, musculoskeletal disorders, fever, migraine, patent ductus arteriosus

Question 34

Precautions of *ibuprofen*?

Answer 34

Pregnancy (1st and 2nd trimester), breastfeeding, children, geriatric, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, HF, CCr <25 mL/min

Question 35

Side effects of *ibuprofen*?

Answer 35

Headaches Feeling dizzy Feeling sick (nausea) Being sick (vomiting) Wind Indigestion

Question 36

Adverse effects of *ibuprofen*?

Answer 36

CV thrombotic events, MI, stroke, *GI bleeding*, *ulceration*, necrotizing enterocolitis, GI perforation, hepatitis, Blood dyscrasias, nephrotoxicity, necrotizing fasciitis, toxic

Question 37

Mode of action of *ibuprofen*?

Answer 37

Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic

Question 38

Nursing assessment of *ibuprofen*?

Answer 38

*GI bleeding/perforation: chronic use can cause gastritis with or without bleeding; in those with a prior history of peptic ulcer disease or GI bleeding, initiate treatment at lower dose; geriatrics are at greater risk, as are those who consume >3 alcohol drinks/day* Assess for infection; may mask symptoms *Assess pain: location, duration, type, intensity before dose, 1 hr after* Assess musculoskeletal status: ROM before dose, 1 hr after *Monitor liver function tests: AST, ALT, bilirubin, creatinine if patient is on long-term therapy, monitor electrolytes as needed, make sure patient is well hydrated* Perioperative pain in CABG: MI and stroke can result for 10-14 days, can be fatal, those taking NSAIDs are at greater risk of MI and stroke, even in first few weeks of therapy Serious skin disorders: For skin rash, swelling of lips, face, tongue, discontinue immediately, provide supportive care Nephrotoxicity: Monitor renal function tests: BUN, urine creatinine if patient is on long-term therapy Identify fever: length of time in evidence and related symptoms Beers: Avoid chronic use in older adults unless other alternatives are not effective, increased risk of GI bleeding Pregnancy: Identify if pregnancy is planned or suspected, if breastfeeding Therapeutic outcome: Decreased pain, inflammation, fever

Question 39

Functional class and chemical class of *azithromycin*?

Answer 39

Functional class: Anti-infective ;Chemical class: Macrolide

Question 40

Purpose of *azithromycin*?

Answer 40

• Mild to moderate infections of the upper respiratory tract • In children: acute otitis media, lower respiratory tract; uncomplicated skin and skin structure infections, nongonococcal urethritis, or cervicitis • Prophylaxis of disseminated Mycobacterium avium complex (MAC); Bacillus anthracis, Bacteroides bivius, Bordetella pertussis, … , viridans streptococci; • opthalmic: bacterial conjunctivitis

Question 41

Precautions of azithromycin?

Answer 41

Pregnancy, breastfeeding, child < 6 mo for otitis media, child <2 yr for pharyngitis, geriatric, renal/hepatic/cardiac disease, tonsillitis, QT prolongation, ulcerative colitis, torsades de pointes, sunlight exposure, sodium restriction, myasthenia gravis, CDAD, contact lenses, hypokalemia, hypomagnesemia

Question 42

Administration of *azithromycin*?

Answer 42

Demonstration PO route • Provide adequate intake of fluids (2 L) during diarrhea episodes • Give with a full glass of water; give susp 1 hr before or 2 hr after meals; tabs may be taken without regard to food; do not give with fruit juices • Store at room temperature • Reconstitute 1 g packet for susp with 60 ml water, mix, rinse glass with more water and have patient drink to consume all medication; packets not for pediatric use • Do not take aluminum/magnesium-containing antacids or food simultaneously with this product Intermittent IV infusion route • Reconstitute 500 mg product/4.8 ml sterile water for inj (100 mg/ml), shake, dilute with ≥ 250 ml 0.9% NaCl, 0.45% NaCl, or LR to 1-2 mg/ml; diluted solution is stable for 24 hr or 7 days if refrigerated • Give 1 mg/ml sol over 3 hr or 2 mg/ml sol over 1 hr, never give IM or as a bolus

Question 43

Side effects of *azithromycin*?

Answer 43

Feeling sick (nausea) Diarrhoea Being sick (vomiting) Losing your appetite Headaches Feeling dizzy or tired Changes to your sense of taste

Question 44

Adverse effects of *azithromycin*?

Answer 44

Seizures, QT prolongation, torsades de pointes (rare), hepatoxicity, cholestatic jaundice, CDAD, leukopenia, thrombocytopenia, Angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis.

Question 45

Mode of action of *azithromycin*?

Answer 45

Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis; much greater spectrum of activity than erythromycin [more effective against gram-negative organisms]

Question 46

Nursing assessment of *azithromycin*?

Answer 46

QT prolongation, torsades de pointes: assess for patients with serious bradycardia, ongoing pro-arrhythmic conditions, or elderly; more common in these patients Assess for serious skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, discontinue if rash occurs Assess for CDAD: blood or pus in diarrhea stool, abdominal pain, fever, fatigue, anorexia; obtain CBC, serum albumin Assess for superinfection: sore throat, mouth, tongue; fever, fatigue, diarrhea, anogenital pruritus Assess for signs and symptoms of infection: drainage, fever, increased WBC >10,000/mm3 , urine culture positive, sore throat, sputum culture positive Therapeutic outcome: Bacteriostatic against the following susceptible organisms: PO, acute pharyngitis/tonsillitis (group A streptococcal); acute skin/soft tissue infections; community-acquired pneumonia