Medication Competency

Question 1

Acetaminophen (PO)

Tylenol

Answer 1

Indication: Mild pain, Fever

Contraindications: Severe hepatic impairment, Active liver disease

Side Effects: Nausea, vomiting

Adverse Reactions: Hepatic impairment, Renal failure, Toxic epidermal necrosis

Nursing Considerations: When calculating daily dose, consider other medications containing acetaminophen, Lower doses for patients with hepatic impairment

Patient Teachings: Take exactly as directed, Notify HCP if fever > 3 days, Discontinue and notify HCP if rash occurs

Question 2

Acetylsalicylic acid (PO)
(Aspirin)

Answer 2

Indication: mild pain, fever, inflammatory disorders, prophylaxis for heart attacks

Contraindications: previous sensitivity to aspirin, cross-sensitivity to other NSAIDS, bleeding disorders

Side Effects: nausea, vomiting

Adverse Reactions: GI bleeding, anaphylaxis, tinnitus

Nursing Considerations: Scheduled doses for inflammatory conditions, Monitor for hypersensitivity reactions, Monitor serum levels >400mcg/mL

Patient Teachings: Consult HCP if tinnitus occurs, or if fever exceeds 3 days, Take with food or water, sit upright for 15-30 min to reduce GI effects

Question 3

Alprazolam (PO)

Answer 3

Indication: Generalized anxiety disorder (GAD), panic disorders, anxiety associated with depression

Contraindications: Previous hypersensitivity, sensitivity to other benzodiazepines, pre-existing CNS depression

Side Effects: nausea, vomiting, dizziness, drowsiness

Adverse Reactions: Blurred vision, tinnitus, chest pain

Nursing Considerations: Monitor patients for S/S of respiratory depression, Give smallest possible therapeutic dose to prevent ataxia

Patient Teachings: Take exactly as prescribed, avoid grapefruit juice and alcohol, drowsiness may occur so avoid driving

Question 4

Amlodipine (PO)

Answer 4

Indication: Hypertension, angina pectoris, spastic angina

Contraindications: Hypersensitivity, Systolic BP <90mmHG

Side Effects: Dizziness, fatigue, flushing

Adverse Reactions: Hypotension, bradycardia

Nursing Considerations: Monitor BP before and during therapy, intake/ output ratios daily, monitor for S/S of heart failure

Patient Teachings: take exactly as prescribed, teach patient to monitor pulse, drowsiness may occur so avoid driving, notify HCP if HR <50bpm

Question 5

Atorvastatin Calcium (PO)

Answer 5

Indication: Management of high cholesterol, Prevention of CAD

Contraindications: Hypersensitivity, Active liver disease

Side Effects: Constipation, diarrhea, flatulence, heartburn

Adverse Reactions: Chest pain, insomnia, memory loss

Nursing Considerations: Obtain baseline lipid profile before treatment, obtain diet history (fat consumption)

Patient Teachings: Take medication exactly as prescribed, medication should be implemented along with diet/ exercise changes

Question 6

Dextromethorphan (PO)

Answer 6

Indication: Coughs caused by upper respiratory infections, Chronic non-productive coughs

Contraindications: Hypersensitivity, chronic productive coughs, patients taking MAO inhibitors or SSRI’s

Side Effects: Nausea, vomiting

Adverse Reactions: Stomach pain, sedation

Nursing Considerations: Monitor cough type and frequency, monitor for symptom improvement

Patient Teachings: Take drug exactly as prescribed and don’t exceed recommended amount, contact HCP if cough last longer than 1 week

Question 7

Diphenhydramine (PO)

Answer 7

Indication: Relief of allergic symptoms, Mild sedation, Prevention of motion sickness

Contraindications: Hypersensitivity, Acute asthma attacks, Known alcohol tolerance

Side Effects: drowsiness, dizziness

Adverse Reactions: Tinnitus, blurred vision

Nursing Considerations: There are multiple uses for this drug, so it’s important to know the reason it was ordered when assessing symptoms.

• Anaphylaxis: assess for hives and airway
• Insomnia: assess sleep patterns
• Motion sickness: assess for nausea, vomiting

Patient Teachings: Take exactly as prescribed. May cause drowsiness so avoid driving. May cause dry mouth - keep up with oral rinses. Teach sleep hygiene, dark quiet room and limit daytime naps.

Question 8

Docusate sodium (PO)

Answer 8

Indication: Constipation, Prevent opioid induced constipation

Contraindications: Hypersensitivity, Abdominal pain

Side Effects: Diarrhea, abdominal cramps

Adverse Reactions: Electrolyte imbalance, urinary discoloration, rash

Nursing Considerations: Determine adequate fluid intake, exercise and diet before administration

Patient Teachings: Laxative should be used for short-term therapy. Teach patient other forms of bowel regulation including increase fluid intake.

Question 9

Famotidine (PO)

Answer 9

Indication: Management of GERD, Acid indigestion, Active duodenal ulcers/ benign gastric ulcers

Contraindications: Hypersensitivity, Patients with phenylketonuria

Side Effects: Diarrhea, drowsiness, dizziness

Adverse Reactions: Arrhythmias, Agranulocytosis, Aplastic anemia

Nursing Considerations: Assess for abdominal pain, Look for blood in emesis/stool/gastric aspirate

Patient Teachings: Take course exactly as directed even if you are feeling better, May cause drowsiness so avoid driving, Avoid alcohol

Question 10

Ferrous Sulfate (PO)

Answer 10

Indication: Iron deficiency anemia

Contraindications: Hypersensitivity, Hemochromatosis (iron overload w/ organ damage), hemosiderosis (iron overload w/o organ damage)

Side Effects: Nausea, vomiting, dark stools

Adverse Reactions: GI bleeding, syncope

Nursing Considerations: Monitor Hb levels, hematocrit/ reticulocyte count during therapy

Patient Teachings: Explain purpose of iron therapy. Stools may appear dark green/black. Educate importance of implementation of high-iron foods.

Question 11

Furosemide (PO)

Answer 11

Indication: Hypertension, HF, edema, renal disease

Contraindications: Hypersensitivity, Cross-sensitivity w/ thiazides and sulfonamides

Side Effects: Diarrhea, dehydration

Adverse Reactions: Stevens-Johnson syndrome, agranulocytosis, aplastic anemia

Nursing Considerations: Monitor BP/ fluid intake output ratios/ weight with longterm use, Stop if oliguria occurs (small amount of urine)

Patient Teachings: Take exactly as directed, Change position slowly to reduce orthostatic hypotension, Call HCP if gain >3lbs in one day

Question 12

Gabapentin (PO)

Answer 12

Indication: Partial seizures, Post-herpetic neuralgia

Contraindications: Hypersensitivity

Side Effects: dizziness, drowsiness, depression

Adverse Reactions: Hypersensitivity reactions, Suicidal thoughts

Nursing Considerations: Monitor patients for changes in behavior (depression, suicidal behavior). When stopping medication, must be stopped gradually over course of >1 week to avoid seizures.

Patient Teachings: Take exactly as prescribed, May cause drowsiness (avoid driving), Call HCP if thoughts of suicide, depression or anxiety occur

Question 13

Guaifenesin

Answer 13

Indication: Coughs caused by upper respiratory infections

Contraindications: Hypersensitivity, Intolerance to alcohol

Side Effects: Nausea, vomiting

Adverse Reactions: Urticaria, Stomach pain

Nursing Considerations: Monitor cough type and frequency

Patient Teachings: Educate to cough effectively (mobilize mucus out of respiratory tract), May cause drowsiness (avoid driving)

Question 14

Hydrochlorothiazide (PO)

Answer 14

Indication: Mild to moderate hypertension, HF, renal dysfunction

Contraindications: Hypersensitivity, Anuria

Side Effects: Nausea, vomiting, dizziness, drowsiness

Adverse Reactions: Hypotension, Stevens-Johnson syndrome

Nursing Considerations: Monitor BP, fluid input & output, daily weight. Assess for skin rash throughout therapy

Patient Teachings: Take exactly as prescribed, Monitor weight biweekly and report significant changes to HCP, Change positions slowly to prevent orthostatic hypotension

Question 15

Ibuprofen (PO)

Answer 15

Indication: Pain, Inflammation, Fever

Contraindications: Hypersensitivity, Concurrent use of other NSAIDs, Active GI bleed or ulcers,

Side Effects: Nausea, vomiting

Adverse Reactions: HF, MI, Stroke, GI bleeding

Nursing Considerations: Assess pain before and 1-2 hours post-administration, Assess for S/S of GI bleeding

Patient Teachings: Take exactly as directed, Avoid drinking alcohol, Take with food, Contact HCP if symptoms persist beyond 10 days or become worse

Question 16

Levothyroxine (PO)

Answer 16

Indication: Thyroid supplement for hypothyroidism, euthyroid goiters

Contraindications: Hypersensitivity, Hyperthyroidism

Side Effects: Sweating, Headache

Adverse Reactions: Tachycardia, arrhythmias, chest pain

Nursing Considerations: Assess apical pulse and BP periodically throughout therapy, Monitor thyroid function prior to and during therapy (TSH levels)
Assess for tachycardia/ chest pain

Patient Teachings: Explain that this is a lifelong therapy, Take medication at the same time each day

Question 17

Lisinopril (PO)

Answer 17

Indication: Hypertension, HF

Contraindications: Hypersensitivity, previous angioedema with other ACE inhibitors

Side Effects: Nausea, vomiting

Adverse Reactions: Hypotension, impaired renal function

Nursing Considerations: Monitor BP and pulse periodically throughout therapy, Assess for signs of angioedema throughout therapy

Patient Teachings: Take medication at same time each day, call HCP if rash/sore throat/fever occurs, change positions slowly to prevent orthostatic hypotension, Do not take if pregnant

Question 18

Loratidine (PO)

Answer 18

Indication: Seasonal allergies, Hives

Contraindications: Hypersensitivity

Side Effects: Drowsiness, Dry mouth

Adverse Reactions: Blurred vision, GI upset

Nursing Considerations: Assess for S/S of allergy, Assess lung sounds and bronchial secretions

Patient Teachings: Take drug exactly as directed, May cause drowsiness (avoid driving), avoid alcohol

Question 19

Losartan (PO)

Answer 19

Indication: Hypertension

Contraindications: Hypersensitivity, Bilateral renal artery stenosis

Side Effects: Diarrhea, dizziness, drowsiness

Adverse Reactions:
Hypotension, Chest pain, angioedema

Nursing Considerations: Assess patient for signs of edema, assess BP and pulse throughout therapy

Patient Teachings: Take exactly as directed, Change positions slowly to prevent orthostatic hypotension, May cause drowsiness (avoid driving)

Question 20

Metformin (PO)

Answer 20

Indication: Type II Diabetes

Contraindications: Hypersensitivity, Diabetic ketoacidosis, Severe renal impairment

Side Effects: Nausea, vomiting

Adverse Reactions: Hypoglycemia, Lactic acidosis

Nursing Considerations: Monitor for S/S of hypoglycemia, Patients with severe renal impairment are at risk for lactic acidosis

Patient Teachings: Take at the same time everyday, Usually long-term therapy, Take with prescribed diet and exercise

Question 21

Ondansetron (PO)

Answer 21

Indication: Prevent nausea and vomiting associated with chemotherapy/ radiation therapy

Contraindications: Hypersensitivity, Use with apomorphine

Side Effects: Diarrhea, constipation

Adverse Reactions: Serotonin syndrome, Stevens-Johnson syndrome

Nursing Considerations: Monitor for S/S of serotonin syndrome, Assess for rash periodically

Patient Teachings: Take medication exactly as directed, call HCP if you have irregular heartbeat, S/S of serotonin syndrome, involuntary movement of eyes/face/limbs

Question 22

Oxycodone (PO)

Answer 22

Indication: Moderate to severe pain

Contraindications: Hypersensitivity, Respiratory depression, acute or severe bronchial asthma

Side Effects: Nausea, vomiting

Adverse Reactions: Respiratory depression, Orthostatic hypotension, Blurred vision

Nursing Considerations: Assess vitals (BP/pulse/RR) before and periodically throughout therapy, assess for risk of opioid addiction, abuse or misuse before administration

Patient Teachings: instruct patient on when and how to take medication, do not share medication with others, advise patient that this medication has abuse potential

Question 23

Potassium (PO)

Answer 23

Indication: Hypokalemia

Contraindications: Hyperkalemia, severe renal impairment, Untreated Addison’s disease

Side Effects: Nausea, vomiting

Adverse Reactions: Arrhythmiaa, GI ulceration, paresthesia

Nursing Considerations: Assess for S/S of hypokalemia

Patient Teachings: Take medication as directed, Encourage compliance with recommended diet

Question 24

Prednisone (PO)

Answer 24

Indication: Inflammation, Immunosuppression, endocrine disorder

Contraindications: Active untreated infections, Osteoporosis or other degenerative bone diseases, Uncontrolled hyperglycemia

Side Effects: Nausea, vomiting, Acne, depression, increased hunger, weight gain

Adverse Reactions: Peptic ulceration, Thromboembolism, Hypertension

Nursing Considerations: Assess for S/S of adrenal insufficiency before and periodically throughout therapy, Monitor intake/output, observe for peripheral edema

Patient Teachings: Take medication as directed, Don’t stop taking suddenly or adrenal insufficiency may occur, Contact HCP if abdominal pain or melena occurs

Question 25

Bacitracin (Topical)

Answer 25

Indication: Prevention of minor skin infections Contraindications: Hypersensitivity, Renal impairment Side Effects: Burning, Redness, Irritation of the skin Adverse Reactions: Rash, Hives, Difficulty breathing Nursing Considerations: Assess lesions prior to and periodically throughout therapy Patient Teachings: Use exactly as directed, Notify HCP if rash, hives or difficulty breathing occurs

Question 26

Fentanyl patch (Topical)

Answer 26

Indication: Moderate to severe chronic pain Contraindications: Hypersensitivity, Respiratory depression, acute/ severe bronchial asthma Side Effects: Nausea, vomiting Adverse Reactions: Respiratory depression, Bradycardia, Hypotension Nursing Considerations: Assess BP/RR/pulse before and throughout therapy , assess risk for opioid addictions use or misuse prior to administration Patient Teachings: instruct how and when to take pain medication, Instruct on proper application and disposal of patch, Avoid water (patch may not stick)

Question 27

Hydrocortisone cream (Topical)

Answer 27

Indication: Inflammation and itching from allergic/immunologic skin problems Contraindications: Hypersensitivity, Untreated bacterial or viral infections (this is a corticosteroid, so it may weaken defenses) Side Effects: Dryness, irritation, burning Adverse Reactions: Edema, Secondary infection Nursing Considerations: Assess skin before and daily throughout therapy, Note degree of inflammation and itching Patient Teachings: Take exactly as directed, Inform proper administration technique, Inform HCP if symptoms do not resolve or if they get worse

Question 28

Lidocaine patch (Topical)

Answer 28

Indication: Pain due to post-op neuralgia Contraindications: Hypersensitivity, 3rd-degree Heart block, Wolf-Parkinson-White Syndrome Side Effects: Nausea, vomiting Adverse Reactions: Seizure, Cardiac arrest Nursing Considerations: Monitor ECG continuously, BP and RR during therapy, monitor for pain throughout therapy Patient Teachings: Explain purpose of patch to patient, Instruct on proper administration/ disposal of patch, Avoid water to ensure the patch sticks

Question 29

Nitroglycerin patch (Topical)

Answer 29

Indication: Long-term prophylactic management of angina pectoris Contraindications: Hypersensitivity, Increased inter-cranial pressure, Severe anemia Side Effects: Nausea, vomiting Adverse Reactions: Hypotension, Contact dermatitis Nursing Considerations: monitor BP and pulse before and after administering, Assess location, duration, intensity and precipitating factors during therapy Patient Teachings: Take drug exactly as directed, Change positions slowly to minimize orthostatic hypotension, Inform HCP if dry mouth or blurred vision occur

Question 30

Enoxaparin (SQ)

Answer 30

Indication: Prevention of VTE, DVT and PE Contraindications: Hypersensitivity Side Effects: Nausea, vomiting, dizziness, Increase in bleeding of gums or menstrual flow, Pain at injection site Adverse Reactions: Bleeding, edema, alopecia Nursing Considerations: Assess for S/S of bleeding, Assess for signs of increased thrombosis, Monitor for hypersensitivity reaction Patient Teachings: instruct patient on correct technique for self-injection care and disposal, Report any symptoms of unusual bleeding or bruising. Don't take aspirin or ibuprofen without consulting doctor.

Question 31

Heparin (SQ)

Answer 31

Indication: Thromboembolitic disorders (VTE/ PE) Contraindications: Hypersensitivity, Uncontrolled bleeding, Open wounds Side Effects: Rash, pain at injection site Adverse Reactions: Bleeding, Heparin-induced thrombocytopenia, alopecia, osteoporosis Nursing Considerations: Assess for S/S of bleeding before and during therapy, Monitor for hypersensitivity reactions, Assess for increased thrombosis Patient Teachings: Report any symptoms of unusual bleeding or bruising immediately, Don't take NSAIDS without consulting HCP, Avoid activities that may lead to injury, Use soft toothbrush and electric razor during therapy

Question 32

Insulin short-acting (Novalog - SQ) | Insulin long-acting (Levimir - SQ)

Answer 32

Indication: Diabetes Contraindications: Hypersensitivity, Hypoglycemia Side Effects: Swelling and itching at injection site Adverse Reactions: Hypersensitivity reactions, Hypoglycemia Nursing Considerations: Assess periodically for S/S of hypo/hyperglycemia, Monitor body weight periodically Patient Teachings: Explain that it is a long-term therapy, Emphasize importance of nutritional/ exercise guidelines, Teach proper administration technique

Question 33

Cyanocobalamin (IM)

Answer 33

Indication: Vitamin B12 deficiency, Pernicious anemia Contraindications: Hypersensitivity Side Effects: Itching, swelling of body Adverse Reactions: Anaphylaxis, HF, pulmonary edema, hypokalemia Nursing Considerations: Assess for S/S of Vitamin B12 deficiency before and periodically throughout therapy Patient Teachings: Consume foods high in Vitamin B12 (meat, seafood, eggs), Encourage compliance with diet, Emphasize importance of follow up and evaluate progress

Question 34

Latanoprost ophthalmic solution (Eye drop)

Answer 34

Indication: Increased intraocular pressure with ocular hypertension or open-angle glaucoma Contraindications: Hypersensitivity, intraocular inflammation Side Effects: Dry eye, Lid discomfort Adverse Reactions: Eye pain, back pain, blurred vision Nursing Considerations: Do not administer while patient is wearing contact lenses, Don't exceed once-daily dosing Patient Teachings: Inform patient of risk of eye color change in treated eye, Darkening of eyelid may occur, Remove contacts before administering and wait 15 minutes to put them back in

Question 35

Timolol (Eye drop)

Answer 35

Indication: Hypertension, prevention of MI, prevent migraine headaches Contraindications: Uncompensated HF, pulmonary edema, bradycardia Side Effects: Fatigue, weakness Adverse Reactions: Anaphylaxis, Arrythmias, HF, pulmonary edema, bradycardia Nursing Considerations: Monitor intake/output ratios and daily weight, assess patient routinely for fluid overload Patient Teachings: Take exactly as directed, Teach how to take BP/ pulse, Call HCP if difficulty breathing/wheezing occurs

Question 36

Albuterol (INH)

Answer 36

Indication: Asthma, COPD, Prevention of exercise-induced bronchospasm Contraindications: Hypersensitivity Side Effects: Nausea, vomiting Adverse Reactions: Wheezing, Chest pain, Palpitations, arrhythmias Nursing Considerations: Observe for wheezing (withhold and notify HCP if this occurs), Assess lung sounds/pulse/BP before and during peak of therapy Patient Teachings: Take exactly as directed, Contact HCP if shortness of breath is not relieved , Inform patient of potential bad taste, Avoid smoking and other respiratory irritants

Question 37

Fluticasone propionate (INH)

Answer 37

Indication: Chronic asthma Contraindications: Hypersensitivity Side Effects: Nausea, vomiting Adverse Reactions: Conjunctivitis, Epistaxis, Pharyngitis, Laryngitis Nursing Considerations: Observe for S/S of system corticosteroid effects, monitor patient during period of stress or severe asthma attack Patient Teachings: Take exactly as prescribed, Contact HCP if medication does not improve asthma episodes, Report all adverse reactions

Question 38

Ipratropium (INH)

Answer 38

Indication: Reversible airway obstruction due to COPD and asthma Contraindications: Hypersensitivity, Avoid during acute bronchospasm Side Effects: Cough, headache, dizziness, dry mouth Adverse Reactions: Blurred vision, hypotension, epistaxis Nursing Considerations: Assess respiratory status before administering and during peak of therapy Patient Teachings: Instruct patient of proper inhaler use and take as directed, Rinse mouth after use, Do not exceed 12 doses in 24 hours

Question 39

Ceftriaxone (IV)

Answer 39

Indication: Infections Contraindications: Hypersensitivity Side Effects: Diarrhea, Rash Adverse Reactions: C.diff-associated diarrhea, Anaphylaxis, Seizures Nursing Considerations: Assess for infection before and during therapy, Obtain specimen for culture and sensitivity before therapy Patient Teachings: Report signs of superinfection and allergic rxn, Notify HCP if diarrhea occurs (contains blood, mucus, pus)

Question 40

Ciprofloxacin (IV)

Answer 40

Indication: Infections Contraindications: Hypersensitivity, Hx of muscle weakness Side Effects: Diarrhea, rash Adverse Reactions: C.diff-associated diarrhea, anaphylaxis, seizures Nursing Considerations: Assess for infection at beginning and throughout therapy, obtain specimen for culture and sensitivity before therapy Patient Teachings: Report signs of superinfection and allergic rxn, Notify HCP if diarrhea occurs (blood, mucus, pus)

Question 41

Doxycycline (IV)

Answer 41

Indication: Infections Contraindications: Hypersensitivity Side Effects: Diarrhea, rash Adverse Reactions: C.diff-associated diarrhea, pancreatitis, hepatoxicity Nursing Considerations: Assess for infection at beginning and throughout therapy, obtain specimen for culture and sensitivity before therapy, monitor bowel function, assess for rash periodically throughout therapy Patient Teachings: Report signs of superinfection and allergy, Notify HCP if diarrhea occurs (blood, mucus, pus)

Question 42

Piperacillin/ Tazobactam (IV)

Answer 42

Indication: Bacterial infections Contraindications: Hypersensitivity Side Effects: Diarrhea, rash Adverse Reactions: C.diff-associated diarrhea, anaphylaxis, seizures Nursing Considerations: Assess for infection at beginning and throughout therapy, obtain specimen for culture and sensitivity before therapy Patient Teachings: Report signs of superinfection and allergy, Notify HCP if diarrhea occurs (blood, mucus, pus)

Question 43

Pantoprazole (IV)

Answer 43

Indication: GERD Contraindications: Hypersensitivity Side Effects: Diarrhea, flatulence Adverse Reactions: C. Diff-associated diarrhea, Bone fractures, Systemic lupus erythmetosis Nursing Considerations: Assess routinely for epigastric and abdominal pain Patient Teachings: Take medication as directed, Notify HCP is fever and diarrhea develop

Question 44

Vancomycin (IV)

Answer 44

Indication: Bacterial infections Contraindications: Hypersensitivity Side Effects: diarrhea, rash Adverse Reactions: Redman's Syndrome (alleviate by lowering rate of infusion), Anaphylaxis, nephrotoxicity Nursing Considerations: Assess for infection recovery, Obtain specimen for culture and sensitivity Patient Teachings: Report any hypersensitivity reaction, tinnitus, vertigo or hearing loss to HCP

Question 45

Metoprolol (PO)

Answer 45

Indication: Hypertension, angina pectoralis Contraindications: HF, Pulmonary edema, Bradycardia Side Effects: nausea, vomitting Adverse Reactions: Worsened HF, Pulmonary edema, Bradycardia Nursing Considerations: Monitor BP, ECG & pulse throughout therapy, monitor intake/output & daily weight Patient Teachings: Take medication exactly as directed, Contact HCP if slow pulse, difficult breathing, or dizziness occurs