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Flashcards in pharm 1234 Deck (163):
1

What should a patient report immediately to a doctor when taking estrogen replacement therapy?

Hypertension, edema, thromboembolism, migraines, depression and breakthrough bleeding

2

What are the contradictions for the use of estrogen medications?

drug allergy, any estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, active thromboembolic disorder (stroke, active smokers) , history of such a disorders

3

What are the indications for medroxyprogesterone?

-amenorrhea, uterine bleeding

4

What are side effects of fertility drugs?

tachycardia, phlebitis, DVT, hypovolemia, dizziness, headache, flushing, depression, restlessness, anxiety, nervousness, fatigue, nausea, bloating, constipation, vomiting, anorexia, urticaria, ovarian hyperstimulation, multiple pregnancies, blurred vision, diplopia, photophobia, breast pain.

5

What is alendronate

an oral biphosphonate

6

What is alendronate used for - indications

prevention and treatment of osteoporosis in post menopausal women and in men

7

3
How could the adverse reaction of Alendronate have been prevented ?

Taken first thing in the morning
- Remain upright in sitting position for 30 minutes after takeing the medication
- DO NOT LIE DOWN FOR UP TO 30 MINUTES

8

What drug interactions are significant with alendronate?

NSAIDS and ASPRIN (drugs that are irritating when they dissolve into solution in the stomach)

- calcium antagonists drugs should be taken 2 hours after alendronate
- take 30 minutes later to prevent effects

9

How is oxytocin administered to induce labour?

IV

10

What medication(s) is used to relax the uterus, or postpone preterm labour?

Tocolytics (NSAIDs indomethacin and naproxen, calcium channel blocker nifedipidine)

11

What increases the risk of thrombosis when a woman is using estrogen therapy?

Raloxifene

12

What are the adverse effects of the medications for osteoporosis?

? -hot flashes and leg cramps, venous thromboembolism, leukopenia, headache, GI upset, joint pain,

13

This estrogen product is made from the urine of pregnant mares

Conjugated estrogen

14

This synthetic progestin is used primarily in the palliative management of recurrent, inoperable, or metastatic endometrial or Brest cancer, but is also used as an appetite stimulant in clients with HIV/AIDS

megestrol acetate

15

this drug is the synthetic form of an endogenous hormone and is used to induce or augment labor

oxytocin

16

This cervical gel is used to improve cervical inducibility or 'ripening' , near or at term in women who need to have labor induced

dinoprostone

17

What are the various types of oral contraceptives? Which one closely duplicates the normal woman hormonal levels of the female menstrual cycle?

Biphasic, triphasic, monophasic. The triphasic duplicates.

18

What is important to consider before starting oral contraceptives?

make sure woman is not pregnant

19

What test should be administered before oral contraceptives are initiated?

pregnancy test

20

What are important considerations to teach patients who take bisphosphonates (e.g. alendronate)?

if they are unable to sit upright or stand after taking medication. Drink big glass of water in AM. May develop osteoporosis in jaw.

21

Why are oxytocics used to treat postpartum and post-abortion bleeding caused by uterine relaxation and enlargement?

Oxytocics work by stimulating the uterus to contract and by inducing vasoconstriction

22

What is the primary mechanism by which oral contraceptives prevent pregnancy?

suppression of the hypothalamic–pituitary system, resulting in the prevention of ovulation
Without ovulation, there is no egg to be fertilized.

23

This progestin is used to treat uterine bleeding, secondary amenorrhea, and endometrial cancer

medroxyprogesterone

24

If a patient is going to be immobile for a considerable amount of time (i.e. long plane trip) and is taking a Selective Estrogen Receptor Modulator (SERM), what should you instruct the patient to do?

withheld medication, sit upright

25

What natural health product has been considered for osteoporosis?

soy

26

How is Depo-Provera®(medroxyprogesterone) administered and what are important considerations?

Intramuscular, concern in woman younger than 25, and if they use it more than 2 years, potential for bone density loss

27

What are some considerations a couple should be aware of when using ovulation-inducing drugs?

multiple pregnancies -twins

28

This drug, available without a prescription, is an emergency post-coital contraceptive.

Levonorgestrel (plan B)

29

This fertility agent is used to induce maturation of the ovarian follicle.

clomiphene

30

Trade name for a progestin-only long-acting injectable contraceptive agent.

Depo-Provera

31

Which of the following statements, made by the client, indicates understanding of discharge teaching regarding alendronate?
A. “I need to decrease my intake of dairy products to prevent hypercalcemia.”
B. “I need to take this medication with food to prevent damage to my esophagus.”
C. “This medication will help relieve the bone pain I have from my osteoporosis.”
D. “I will take the medication first thing in the morning on an empty stomach and remain upright for 30 minutes.”

D. “I will take the medication first thing in the morning on an empty stomach and remain upright for 30 minutes.”

32

**For which of the following cancers is the risk reduced with the addition of continuous administration of progestin to an estrogen regimen?
A. Breast cancer
B. Vaginal cancer
C. Ovarian cancer
D. Endometrial cancer

D. Endometrial cancer

33

For a client with which of the following conditions would the nurse question the order for estrogen replacement therapy?
A. Weight loss
B. Dysmenorrhea
C. Vaginal bleeding
D. Deep vein thrombosis

D. Deep vein thrombosis

34

During postpartum assessment the nurse notes a boggy uterus and increased vaginal bleeding. Which of the following drugs would the nurse anticipate to administer based upon this assessment and standing physician orders?
A. oxytocin
B. terbutaline
C. clomiphene
D. prostaglandin E

A. oxytocin

35

Finasteride is used in the treatment of ______________________.

benign prostatic hypertrophy

36

Fluoxymesterone is contraindicated in what conditions or diseases?

- Cardiac dysfunction
- hepatic dysfunction
- renal dysfunction
- pregnant or breast feeding
- breast cancer patients

37

True or false?
Sildenafil may be used by almost all men without any major complications or contraindications.

false
There are many complications, and several of them may be severe in nature

38

Danazol is indicated in the treatment of __________________.

endometriosis and fibrocystic breast disease

39

Three common side effects of danazol include __________________, _________________, and ____________________.

acne, Gynecomastia, amenorrhea, and menstrual irregularities.

40

Describe precautions female nurses should take when handling finasteride tablets

Pregnant women
- should not handle crushed or broken tablets on a regular basis because of the possibility of topical absorption, which can lead to teratogenic effects

41

Which medications are used for erectile dysfunction?-

viagra –sildenafil

42

what are some severe adverse effects of androgenic steroids?

?-headache, changes in libido, anxiety, depression, acne, male pattern hair loss, hirsutism, nausea, abnormal liver function test results, priapism, elevated cholesterol level

43

What is peliosis of the liver?

is an uncommon vascular condition characterised by multiple, randomly distributed, blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres and 3 cm in diameter.

44

What is priapism?

persistent and painful erection of the penis.

45

What are side effects of finasteride (Proscar)?-

increased hair growth, impotence, loss of interest in sex, or trouble having an orgasm;
abnormal ejaculation;
swelling in your hands or feet;
swelling or tenderness in your breasts;

46

What condition may a woman take testosterone medication?

breast cancer

47

Which medication should a pregnant woman not handle?-

finasteride

48

What are important considerations for a man taking sildenafil? What condition and which medications are contradicted?

Contraindicated: hypersentivity to it. Sildenafil can hypersentive effects to nitrates.Use of sildenafil, vardenafil, and tadalafil is also contraindicated in men with major cardiovascular disorders, especially if they use nitrate medications such as nitroglycerin. Concurrent use of erectile dysfunction drugs and nitrates may cause severe hypotension, which may not respond to treatment.

49

Consider the indications for finasteride?

benign prostatic hyperplasia, male androgenetic alopecia, It is used to treat the signs of an enlarged prostate. It may take a few months to see the full effect.

50

What is a herbal product that may be useful in the early stages of benign prostate hypertrophy?

Saw palmetto

51

What are some Ethnocultural considerations for men’s health drugs?

Black men have the highest rate of prostate cancer in the world, and have a greater chance of dying from prostate cancer than white men.

52

When using sildenafil, which pharmacokinetic property is important to consider for older men?

Increase plasma concentration

53

Which of the following dosage forms for testosterone allows for the highest hepatic first-pass effect?
A. Oral
B. Buccal
C. Transdermal
D. Subcutaneous

A. Oral

54

25
For which of the following laboratory values would the nurse question the administration of testosterone?
A. Hypocalcemia
B. Hyponatremia
C. Hyperkalemia
D. Hypovolemia

C. Hyperkalemia

55

Discharge teaching for a client receiving finasteride would include which of the following common side effects?
A. Hair loss
B. Increased libido
C. Muscle weakness
D. Ejaculatory dysfunction

D. Ejaculatory dysfunction

56

With which of the following drugs would clients prescribed sildenafil be instructed regarding a potential fatal drug interaction?
A. aspirin
B. nitroglycerin
C. acetaminophen
D. anticoagulants

B. nitroglycerin

57

What is an example of an Estrogen-dependent cancer?

Breast Cancer

58

what is another word for thromboembolic?

Embolism

59

What health teaching would you do for a patient on estrogen?

Teach to report any weight gain of 2.25 kg or more

60

what is an adverse effect of Contraceptive drugs?

Benign liver tumors

61

what is Raloxifene (Evista)?

Selective Estrogen receptor modulatiors (SERMs) used for the treatment of Osteoporosis.

62

What is a contraindication for drugs used for the treatment of osteoporosis?

Hypocalcemia

63

what is an adverse effect of drugs used for the treatment of osteoporosis?

Risk of esophageal burns if medication lodges in esophagus before reaching the stomach

64

What are signs and symptoms of a ''boggy'' uterus ?

-Soft
-excessive bleeding

65

What is an nursing implementation for medication administration of Poticin ?

Administer Via IV pump

66

What are nursing implications for Bisphosphonates?

- Ensure that the patient has no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose
Instruct patient to take medication upon rising in the morning, with a full glass of water , and 30 minutes before eating

67

The nurse is assessing a patient who is to receive dinoprostostone. Which of the following would be a contraindication to the use of this drug?
a) Ectopic pregnancy
b) Incomplete abortion
c) Pregnancy at 15 weeks
d) Gastrointestinal upset or ulcer disease

a) Ectopic pregnancy

68

When teaching a patient who is taking oral contraceptive therapy for the first time, which of the following adverse effects should the nurse tell the patient about?
a) Polyuria
b) Dizziness
c) Nausea and vomiting
d) Tingling in the extremities

c) Nausea and vomiting

69

Which of the following situations is an indication for an oxytocin infusion?
a) Hypertonic uterus
b) Induction of labour at full term
c) Termination of a pregnancy at 12 weeks
d) Cervical stenosis in a patient who is in labour

b) Induction of labour at full term

70

After a patient has been taught about drug therapy with the SERM raloxifene, which statement from the patient reflects a good understanding of the instruction?
a) "After I take this drug I must sit upright for at least 30 minutes."
b) "One advantage of this drug is that it will reduce my hot flashes."
c) "I will need to stop taking this drug at least 3 days before I travel to Europe."
d) "I can continue this drug even when travelling as long as I take it with 340mL of water each time

c) "I will need to stop taking this drug at least 3 days before I travel to Europe."

71

A patient calls the clinic because she has realized that she has missed one dose of an oral contraceptive. Select all statements that are appropriate response from the nurse.
a) "Wait 7 days, then start a new pack of pills."
b) "Don't worry, you are still protected from pregnancy."
c) "Please come in to the clinic for a re-evaluation of your therapy."
d) "Go ahead and take the missed dose now, along with today's dose."
e) "You will need to use a backup form of contraception until the next cycle."

d) "Go ahead and take the missed dose now, along with today's dose."
e) "You will need to use a backup form of contraception until the next cycle."

72

K.T. has spent 14 hours in labor and has made little progress. This is her first pregnancy, and she is exhausted, and the uterine contractions have decreased in strength. She is now receiving an oxytocin infusion. What will you monitor while she is receiving this drug?

- maternal blood pressure, pulse, contractions, and fluid status is needed
- fetal heart rate monitoring (during and between contractions).
- strength and length of the contractions; prolonged contractions (longer than one minute) may require the infusion to be stopped.

73

Which is important to monitor when a patient is taking finasteride (Proscar)?
a) PSA levels
b) Blood pressure
c) Fluid retention
d) Complete blood count

a) PSA levels

74

The nurse is performing an assessment of a patient who is asking for a prescription for sildenafil (Viargra). Which of the following findings would be a contraindication to its use?
a) Age 65 years
b) History of hypertension
c) Medication list that include nitrates
d) Medication list that includes saw palmetto

c) Medication list that include nitrates

75

During a counselling session for a group a teenager athletes, the use of androgenic steroids is discussed. Which of the following is a rare but devastating effect of androgenic steroid use that the nurse should discuss?
a) Bradycardia
b) Kidney failure
c) Peliosis of the liver
d) Tachydysrhythmias

c) Peliosis of the liver

76

The nurse is teaching a patient about the possible adverse effects of erectile dysfunction drugs. If the patient experiences priapism, or an erection tat lasts longer than 4 hours, which of the following should he know to do?
a) Seek medical attention
b) Turn on his left side and rest
c) Apply an ice pack for 30 minutes
d) Stay in bed until the erection ceases

a) Seek medical attention

77

A patient is asking about the use of saw palmetto for prostate health. Which of the following drugs interact with saw palmetto?
a) Nitrates
b) Antihypertensive drugs
c) Acetaminophen (Tylenol)
d) Nonsteroidal anti-inflammatory drug

d) Nonsteroidal anti-inflammatory drug

78

How do finasteride and testosterone differ in their mechanisms of action?

Finasteride inhibits the production of testosterone. Methyltestosterone mimics the action of testosterone. Androgens such as methyltestosterone also stimulate the production of erythrocytes by enhancing the production of erythropoietic stimulating factor

79

True or False?
acetaminophen is an NSAID and exerts anti-inflammatory, antipyretic, analgesic, and antiplatelet effects.

False.

80

What are the possible therapeutic effects of NSAIDS?

Analgesic activity, anti-inflammatory activity, antipyretic activity, antiarthritic activities

81

What medications have an interaction with NSAIDS?

Alcohol, anticoagulants, acetylsalicylic acid (ASA), biphosphonates, corticosteroids and other ulcerogenic medications, protein-bound drugs, diuretics and ACE inhibitors

82

Salicylates and other NSAIDs: Drug Interactions
What are the common signs of chronic salicylate intoxication?

? Increased heart rate; tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, drowsiness; nausea, vomiting, diarrhea; sweating, thirst, hyperventilation, hypoglycemia or hyperglycemia

83

What is the pathology of gout?

Gout is caused by the overproduction of uric acid or decreased uric acid excretion or both. This overproduction or decreased secretion often result un hyperuricemia.

84

What health teaching information is important for patients in colchicine?

Monitor patient closely for any increased pain, blood in urine, excessive fatigue and lethargy, or chills or fever

85

Where an IM ketorolac injection should be administered?

Vastus lateralis

86

Why is misoprostol used with patients with NSAIDs?

? Helps prevent gastric ulcers

87

What is the purpose of ASA 81mg?

prophylactic therapy for adults who have strong risk factors for developing coronary artery disease or cardiovascular accident

88

Which natural health product may be used for osteoarthritis?

Glucosamine and chondroitin

89

what are drug interactions for NSAIDS?

-alcohol,
-anticoagulants,
-aspirin and other NSAIDS,
-corticosteroids,
-protein bound drug,
-hypotensive agents
-diuretics.

90

what can result from an interaction with alcohol?

increased GI bleeding

91

what can result from an interaction with anticoagulants?

increased bleeding with platelet inhibition and hypothrombinemia

92

what can result from an interaction with aspirin and other NSAIDS?

increased GI upset
Increased ulcerogenic
Increased bleeding,
Increased toxicities

93

What can result from an interaction with corticosteroids

increased ulcerogenic effects

94

what can result from an interaction with hypotensive agents and diuretics?

reduced hypotensive and diuretic effects

95

The abbreviation "NSAID" stands for?

Non-Steroidal anti-inflammatory drug

96

the generic name for a prescription drug used in Canada to prevent gastric ulcers in clients receiving NSAIDs is ?

misoprostol

97

NSAIDs share these four properties:

-antipyretic,
-analgesic,
-anti-inflammatory
-antirheumatic

98

ASA has this additional property:

antiplatelet

99

These three symptoms are consequences of the activation of the arachidonic acid intoxication

pain, headache, and fever

100

Tinnitus and hearing loss are the most common manifestations of (acute or chronic) salicylate intoxication.

chronic

101

The dosage of ASA required for prophylactic therapy for adults who have strong risk factors for developing coronary artery disease or stroke is:

81 mg or 325mg, 1 tablet, daily

102

This NSAID has powerful analgesic effects comparable to those of narcotic agents such as morphine:

ketorolac

103

this drug is indicated for clients whose gout is caused by excessive production of uric acid

allopurinol

104

this element is an active ingredient in anti-arthritic agents known as disease-modidying antirheumatic drugs (DMARDs):

gold

105

what are three indications for ibuprofen

mild to moderate pain
-headache
-post op pain,
-musculoskeletal injuries/inflammation
-dysmenorrhea
-arthritis
-osteoarthritis
-fever
-bursitis
-rheumatoid arthritis
-tendonitis

106

list at least five side effects or non-steroidal anti-inflammatory drugs (NSAIDS)

-GI upset
-nausea and vomiting
-ulcer formation
-dyspenia
-epigastric distress
-acute tubular necrosis
-hepatotoxicity
-skin eruption
-hearing loss
-tinnitus
-altered platelet functioning

107

what is Ketorolac used for?

- treatment of severe acute pain that may occur as a result of orthopedic injuries.
-it is a potent analgesic

108

which medication is indicated for prevention of NSAID-induced peptic ulcer disease?

Cytotec

109

name at least two drugs interations that may occur with COX-2 selective inhibitor

alcohol (ethanol),
- over the counter agents
- angiotensin converting enzyme inhibitors diuretics,
-salicylates,
-corticosteroids,
-warfarin,
-lithium,
-anticoagulants

110

what to monitor when on allopurinol?

Uric Acid levels

111

What should the nurse say to a pregnant woman who is considering natural health projects?

Herbal products may not be safe

112

Understand the role of Natural Health Products Directorate (NPHD).

Manufacturers must obtain a product license from Health Canada in order to sell their products in Canada

113

What are some considerations when using Kava?

Liver toxicity

114

Which drugs are contradicted with St. John’s Wort?

Use of St. John’s wort with serotonergic drugs may lead to serotonin syndrome

115

What medication may interact with garlic?

? Herbal products can increase bleeding risk with warfarin sodium, potentiate digoxin toxicity, increase the effects of antihypertensives agents, and cause heart block or dysrhythmias; can interfere with anticoagulant therapy and hypoglycemic therapy

116

Consider Ethnocultural considerations for natural health products.

Japanese persons may not report GI adverse reactions from OTC or NPH supplements as they may find it unacceptable

117

If a patient is on Ginko Bilobo what drugs should they avoid?

NSAIDs
ASA
Warfarin

118

what should you inform your patient to report when on Colchicine?

Increased pain
excessive fatigue
blood in urine

119

what is Misoprostol (cytolec) used for ?

used to reduce GI bleeding and mucosal lesions when taking NSAIDs.

120

would you give salicylates to children under 12? why ?

NO.
because of the risk of Reye's syndrome

121

why should you avoid taking garlic or garlic tablets when on NSAIDs?

It enhances platelet formation

122

TRUE OR FALSE?
OTC agents and natural health products may be safely taken in the recommended amounts without concern about adverse effects

False
- there are many adverse effects and significant drug interactions for over-the-counter agents and natural health products. just because a drug is available OTC does not guarantee that it is risk free.

123

what are indications for St.Johns Wort and ginseng?

St. Johns wort: is often called the ''herbal Prozac'' and is used for depression, anxiety, sleep disorders, and nervousness
Ginseng: used for stimulant and an analgesic

124

what are side effects to emphasize in client education about st. johns wort and ginseng?

St. Johns wort: GI upset
Ginseng: hypertension, diarrhea, nervousness, depression, headache, amenorrhea, insomnia, skin rash

125

what are cautions for St. Johns wort and Ginseng that you can identify based on the side effects?


St. Johns wort: caution in being used in client with any type of GI upset
Ginseng: cautions include hypertension, menstrual irregularities, and sleep disorders

126

TRUE OR FALSE
Natural health products are always safe to use.

FALSE.
based on the side effects associated with many of the products, such as ginseng, st.john wort, valerian, and ginko, the client should used these products with caution because they may have side effects that could result in harm to the client. Natural health products also have many significant drug interactions that could result in additional harm to clients.

127

TRUE OR FALSE
if a drug is over the counter, it is always safe to use

False
Over-The-Counter drugs status is not a guarantee of drug safety

128

which of the following statements is accurate when discussing self-treatment options with a client ?
a) over the counter meds are not as potent as prescribed drugs
b) herbal remedies have not demonstrated any adverse effects with their use
c) the use of over the counter meds is gradually decreasing with the increased availability of more effective prescription medications
d) over the counter medications can, at times, be used in place of prescription drugs. it is important to discuss the use of these with your healthcare provider

d) over the counter medications can, at times, be used in place of prescription drugs. it is important to discuss the use of these with your healthcare provider

129

Which of the following would be the nurse's best response when the client questions a nurse about natural health/herbal treatments for arthritic pain?
A. “Ginkgo biloba has shown tremendous benefit as an anti-inflammatory agent.”
B. “High doses of vitamins have been used for many years to help maintain joint health.”
C. “There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications.”
D. “Glucosamine sulphate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain. Consult your healthcare provider.”

D. “Glucosamine sulphate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain. Consult your healthcare provider.”

130

What conditions are caused by Vitamin D deficiency?

Rickets – symptoms include soft, pliable bones, which cause deformities such as bow legs and knock knees; nodular enlargement on the ends and sides of the bones; muscle pain; enlarged skull; chest deformities; spinal curvature; enlargement of the liver and spleen; profuse sweating; and general tenderness of the body when touched

131

What are the indications for Vitamin A?

Night blindness

132

What are the symptoms of Vitamins D toxicity?

Anorexia

133

Which drugs may interact with calcium supplements?

Calcium salts with bind (chelate) with tetracyclines to produce an insoluble complex+

134

What are the calcium salt adverse effects?

Hypercalcemia (anorexia, nausea, vomiting, constipation, heart irregularities, delirium, coma)

135

What are the indications for Vitamin K?

Given prophylactically to newborn infants

136

What deficiency is connected to Wernicke’s encephalopathy?

Vitamin B1 (thiamine) deficiency

137

What vitamin is important for northern Canadians to consider?

Vitamin D

138

How are calcium and phosphorus related to the intake of vitamin D?

The basic function of vitamin D is to regulate the absorption and subsequent utilization of calcium and phosphorus—primarily for bone calcification

139

Your client is experiencing constipation and abdominal pain since beginning calcium therapy. Your assessment reveals a distended abdomen and diminished bowel sounds. What could be occurring, and what should your nursing actions be at this time?

Hypercalcemia or rintestinal obstruction may be the cause behind the abdominal pain and constipation.
- The physician should be notified immediately, a head-to-toe assessment completed and vital signs and bowel sounds documented.

140

Ms. W. takes 2500 mg of calcium carbonate daily in the form of an OTC calcium supplement. How much elemental calcium is Ms. W. actually taking?

The 2.5 g of calcium carbonate is equal to a daily dose of 1000 mg/day of elemental calcium.

141

When administering intravenous magnesium sulphate, the nurse will monitor for which signs and symptoms of hypermagnesemia?
A. Diaphoresis
B. Hyperthermia
C. Depressed deep tendon reflexes
D. All of the above

C. Depressed deep tendon reflexes

142

For which of the following conditions is cyanocobalamin indicated?
A. Pernicious anemia
B. Optic nerve atrophy
C. Bone marrow suppression
D. Acute lymphocytic leukemia

A. Pernicious anemia

143

Client teaching regarding the administration of vitamin C would include which of the following indications of toxicity?
A. Constipation
B. Seizure activity
C. Excessive bleeding tendencies
D. Nausea, vomiting, and abdominal cramping

D. Nausea, vomiting, and abdominal cramping

144

Which of the following would a client receiving vitamin K most likely demonstrate?
A. Diarrhea
B. Confusion
C. Seizure activity
D. Altered coagulation studies

D. Altered coagulation studies

145

The nurse would question a physician's order for vitamin D in a client with which of the following diagnosis?
A. Chronic renal failure
B. Hypothyroidism
C. Hyperparathyroidism
D. Graves’ disease

C. Hyperparathyroidism

146

what are side affects of TPN

watery poops

147

list 3 indications for TPN

- procedures that impose restriction on oral feedings
GI illness
-Anorexia caused by radiation or cancer chemotherapy
- post op

148

TRUE OR FALSE
fats and or lipids emulsion infusion are always included in TPN

fulse
fat or lipids emulsions are used only to meet caloric needs in the prevention of potentially harmful conditions, such as hyperglycemia, hyperinsulinemia, and hyperosmolarity, that can occur when a client entire caloric needs are being met solely by dextrose.

149

What are the indications for central TPN?

Anorexia caused by chemotherapy or radiation treatments

150

What are adverse effects of TPN?

Phlebitis is the most devastating adverse effect and can lead to loss of a limb; fluid overload

151

Understand rebound hypoglycemia.

If TPN is discontinues abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels

152

Review the residual volume and consider the actions to be taken.

If the volume aspirated is greater than the total amount administered over the last two hours, return to aspirate, stop the feed, eep the head of the bed elevated, and call HCP

153

Understand long-term complications of TPN.

Hyperglycemia

154

What are signs and symptoms of fluid overload?

Weak pulse, hypertension, tachycardia, confusion, decreased urine output, pitting edema

155

How often should you assess the TPN infusion? Every 60 minutes
Which solution should be hung with peripheral parenteral nutrition?

Hang a bang of 10% dextrose: PTN infusion should have no more than 10% concentrations of dextrose fluids because higher concentrations can cause sclerosing of the vein. IF the new bag is not ready, it is important to hang the 10% dextrose solution to prevent a sudden drop in serum glucose levels

156

list 3 complications of centrally administered TPN

- insertion of the line into the central vein, catheter induced trauma
- technical or mechanical problems
metabolic conditions such as hyperglycemia
- infection with possible sepsis

157

central parenteral nutrition may benefit what specific groups of clients?

- fluid-restricted clients such as renal failure and heart failure
- clients with large nutritional requirments such as those with metabolic stress or hypermetabolism
- clients with needing nutrititonal support for prolonged periods of time, such as 7-10 days

158

TRUE OR FALSE
Ten Percent of concentration dextrose intravenous solutions are always given via a peripheral vein site

False.
peripherally parenteral nutrition is limited to lower concentrated solutions, generally less than 10 percent concentrations, to avoid sclerosing of the vein.

159

what other agents, other than fats, carbohydrates, and amino acids, may be added to TPN solutions ?

trace elements, vitaimns, and minerals

160

which nursing actions will help address the nursing diagnosis of diarrhea as related to enteral feedings?

- recording the frequency and consistency of stools,
- decreasing the hypertonicity of feedings by adding additional water,
- administering antidiarrheals, as ordered

161

what outcome criteria will address the nursing diagnosis of deficient fluid volume related to imbalanced nutrition?

- fluid balance will be regained or maintained while the client is receiving TPN or enteral feeding

162

what is the concern relating to abrupt withdrawal of a 10 percent glucse TPN solution?

rebound hypoglycemia may occur with this high dose of glucose in the TPN and that any sudden withdrawal of the TPN would result in the rebound phenomenon

163

Nursing responsibilities associated with the care of a client receiving total parenteral nutrition (TPN) would include which of the following? (choose all that apply)
A. Monitoring capillary serum glucose every 6 hours
B. Protecting the solution from exposure to light at all times
C. Maintaining sterile asepsis when handling the site or solution
D. Accelerating the rate of infusion to keep the infusion on time as needed

A. Monitoring capillary serum glucose every 6 hours
D. Accelerating the rate of infusion to keep the infusion on time as needed