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What is succimer and what is the NSG main priority?

Succimer is used in managing lead poisoning. Main priority is to check CBC count as this drug can cause neutropenia. Stop med if ANC is less than 1200/u


What is the priority assessment of a pt receiving IV NTG?

IV nitroglycerine causes vasodilation and profound hypotension occurs w/IV route. Check BP q 15 min until stable, and 30 min there after. They need to be on ECG monitor


Aluminum hydroxide indication and therapeutic effect?

aluminum hydroxide for CRF pts. Aluminum hydroxide is an antiacid that binds to phosphate to decrease its levels


What lab finding would indicate a risk of gentamicin toxicity

High serum creatinine d/t reduced renal f(x) which delays excretion of meds


Teaching for dexamethasone

dexamethasone is a glucocorticosteroid used for anti-inflammatory properties, best taken in the AM w/food or milk to avoid GI, can cause Na/H2O retention and hypokalemia/hypocalcemia. Pt should take calcium supplements, pts should avoid immunizations or skin tests d/t risks for infections


Pt asks why he shouldn't abruptly stop his propranolol?

Sudden cessation of propranolol (BB) leads to angina, HTN, arrhythmias, MI


A client taking isoniazid for tuberculosis (TB) asks the nurse about the side effects of this medication. The client should be instructed to report which of these findings?

Report Extremity tingling & numbness.

Peripheral neuropathy is a common side effect of isoniazid and other antitubercular medications and should be reported to the health care provider. Daily doses of pyridoxine (vitamin B6) may lessen or even reverse peripheral neuropathy due to isoniazid use


What med can lessen or reverse peripheral neuropathy?

pyridoxine (V. B6)


The client with cancer is being treated with a biological response modifier. Which of the following side effects does the nurse anticipate with biologic therapy?

A: Photophobia and sun sensitivity

B: Hematuria

C: Chills & fever

D: Constipation

C: Chills & fever

Biological response modifier cancer therapy agents (for example, interferons and interleukins) are drugs that stimulate the body's own defense mechanisms to fight cancer cells. Flu-like findings such as chills, fever and nausea, are common side effects of this type of therapy. The other assessment findings are not what you would expect when the body is fighting pathogens.


A client has had a positive reaction to purified protein derivative (PPD). When the client asks, “What does this mean?” the nurse should respond with which statement?

A: This means you have never had or been around someone w/TB

B: You have been exposed to the organism Mycobacterium tuberculosis

C: You are mostly likely have a natural immunity to the bacteria

D: You most likely have a resistant form of active TB

B: You have been exposed to the organism Mycobacterium tuberculosis

The PPD skin test is used to determine the presence of tuberculosis antibodies. In an otherwise healthy person, an induration greater than or equal to 15 mm is considered a positive skin test. This indicates that the client has been exposed to the organism Mycobacterium tuberculosis. Additional tests such as a chest x-ray and sputum culture will be needed to determine if active tuberculosis is present. The sputum cytology test is the only definitive test to confirm a diagnosis of active TB.


The nurse is preparing to administer albuterol inhaled (AccuNeb, ProAir HFA, Proventil HFA, Ventolin HFA) to a 11 year-old with asthma. Which assessment by the nurse indicates there is a need for the health care provider to adjust the medication?

A: Apical pulse of 112

B: LE edema

C: Lethargy

D: Temp of 101 F

A: Apical pulse of 112

One of the more common adverse effects of beta adrenergic medications is an increase in heart rate. Normal resting heart rate for children 10 years and older is the same as adults: 60-100 beats per minute.


A client is started on long-term corticosteroid therapy. Which comment by the client indicates a need for more teaching?

A: I will be sure to eat foods high in potassium

B: For one week every month I will stop taking the medication

C: The medication needs to be taken w/food

D: I will keep a weekly weight record

B: For one week a month, I will stop taking the medication

To suddenly stop taking a steroid may result in a sudden drop in the blood pressure from a loss in fluid volume associated with adrenal crisis. Clients should be warned not to abruptly stop taking the medication. Corticosteroids can lower the amount of potassium in the body so the client should eat more potassium-rich foods. Weight gain is an expected effect of corticosteroid therapy; clients should regularly keep track of their weight. Normally corticosteroid medications are taken with breakfast.


An 8 year-old child is brought to the clinic by a parent who states: "This child was so sick last year with cold and the flu. I want her to have the influenza vaccine this year." The nurse assesses the child and reviews the child's history. What information would the nurse recognize as a contraindication for giving the child this vaccine?

A: Persistent, inconsolable crying after receiving other immunizations

B: Family history of convulsions

C: Allergy to eggs

D: Recent exposure to an infectious Dz

C: Allergy to eggs

An allergy to egg proteins is listed by the CDC as a contraindication for administering the influenza vaccine. Influenza vaccines are grown on egg embryos and may contain a small amount of egg protein.


The nurse admitting an 80 year-old client with Alzheimer's disease to a memory care facility is conducting a medication assessment. The nurse would question the use of which of the following alternative and complementary therapies in this client?

A: Coenzyme Q10

B: Milk thistle

C: Echinacea

D: Ginkgo biloba


Echinacea and ginseng are not reported to enhance memory or delay Alzheimer's disease. Echinacea is used to support immune function. Ginseng is used as a stimulant to improve energy. This supplement may contribute to sleep-wake cycle abnormalities common in Alzheimer's, and may worsen blood pressure and heart problems in the older adult. The other substances may have some benefit for cognition and/or may protect against Alzheimer's disease.


Classes of drugs that end in "PRILS"

ACE inhibitors (enalapril, lisinopril)


Classes of drugs that end in "SARTANS"

angiotensin receptor blockers (losartan, valsartan)


Classes of drugs that end in "TRIPTANS"

treatment of acute migraine HA


Classes of drugs that end in "STATINS"

lower LDL cholesterol (simvastatin, rosuvastatin)


Classes of drugs that end in "DIPINES"

calcium channel blockers (amlodipine, nifedipine)


Classes of drugs that end in "PRAZOLES"

PPI (omeprazole)


Classes of drugs that end in "AZOLES"

antifungals (miconazole)


Peak & Trough levels

Peak: the point when the medication exerts its strongest therapeutic/adverse effect; bld sample is drawn about 30min -1 hr after the drug is administered

Trough: the lowest level that is needed to reach therapeutic range; blood is drawn 30 min before medication administration


Proper way to use an aerosol:

Slow, deep inhalation, hold breath for 5-10 sec after inhalation


Proper way to use a MDI w/o spacer:

Shake canister for 2-5 sec; hold MDI w/thumb under the mouth piece and the index & middle finger on top of canister; place mouthpiece in mouth w/lips tighten over it OR position MDI mouthpiece 1-2 inches in front of widely opened mouth w/lips not touching it; inhale slowly for 2-5 sec while depressing canister; then hold breath for 10 sec; rinse mouth after using MDI; wait 20-30 sec between puffs before administering second puff or other MDI meds


Proper way to use Nebulizer:

Instruct pt to inhale slowly and deeply, hold breath for a second, then passively exhale, tap medication cap toward end of the treatment

Check pts HR before and after tx, provide oral rinse, check bilateral breath sounds, SaO2, HR


IM route for children

< 18 mo = vastus lateralis muscle
> 18 mo = vastus lateralis, ventrogluteal, deltoid
inject up to 2 mL (deltoid 0.5-1 mL)


Peripherally inserted central cath (PICC) sites:

Thru a peripheral vein (basilica, cephalic, brachial; cath ends before superior vena cava; can stay in as long as a year


Central venous cath (central lines) sites

inserted thru subclavian vein; types (Broviac, Hickman, Groshong)


Ear drop technique:

< 3 = pull lobe down and back
> 3 = pull pinna up and back

Instruct pt to remain in place for 5-10 min & wait 5-10 min before repeating in the other ear if necessary


HYperglycemia S/S from TPN:

3 Ps: nausea, weakness, thirst, HA, tachypnea


HYPOglycemia S/S from TPN:

diaphoresis, tachycardia, hunger, trembling, confusion


Refeeding syndrome from TPN:

First 24-48 hrs of therapy: bradypnea, lethargy, confusion, weakness


How to prevent air emboli cath complication:

Use Luer-Lok connections; occlusive dressing, clamp tubing when changing solution/tubing, position pt in supine position or have them perform Valsalva maneuver


What are the S/S of a pt w/TRALI (transfusion-related acute lung injury:

TRALI commonly occurs w/platelets or plasma and in pts who are gravely ill

Trouble breathing (1-2 hrs - 72 hrs post transfusion)


Intervention for transfusion complication of circulatory overload:

Circulatory overload (cough, SOB, crackles, HTN, tachycardia, neck veins) = place in high Fowler's, diuretics, O2, monitor I&Os


Intervention for transfusion complication of sepsis:

sepsis (rapid onset of chills/fever, vomiting, diarrhea, hypotension, shock) = obtain bld Cx, send bld transfusion bag for analysis, treat sepsis w/Abx/IVF/Vasopressors/steroids


The nurse asks the client with emphysema to “bear down” during insertion of a non-tunneled central venous catheter (CVC).

True or false?


Intravenous pressure must exceed atmospheric pressure during CVC insertion to prevent air from entering the catheter and traveling to the heart and lungs. Any client, regardless of the diagnosis, should be asked to “bear down” during CVC insertion.


Do not crush any oral medication that ends in the following letters



AntiHTN Interventions:

Concern: orthostatic hypotension, fluid and electrolyte imbalance

assist with activity; eliminate drug interactions, vasodilators, central nervous system depressants

blood pressure for hypotension if they are taking a diuretic also, pulse, breath sounds, serum electrolyte levels, edema, dizziness

Client teaching: get help to stand, report dizziness; avoid alcohol, sedatives, over-the-counter agents, caffeine, change positions slowly. Reinforce client to take blood pressure and pulse daily.


Anticholinergic agents interventions:

Concern: dry mouth, constipation, blurred vision

provide sips of water and oral care; assist with activity; remove environmental hazards

Monitor: bowel pattern, vision, oral mucous membranes

Client teaching: frequent oral care, avoid dangerous activity, ask for help to stand


ANticoag Interventions

Concerns: Bleeding

minimize invasive procedures, shaving; provide gentle oral care; assist with activity

Monitor: bleeding, coagulation tests, complete blood count, bruising; remove adverse drug and food affects

Client teaching: avoid dangerous activity, wear MedicAlert® identification, avoid NSAIDs, alcohol, avoid eating food rich in vitamin K


Anticonvulsants Interventions:

Concerns: CNS depression, myelosuppression: infection and bleeding

assist with activity; protect airway, breathing; minimize invasive procedures

Monitor: seizure activity, complete blood count with differential, temperature, regional redness, swelling, or drainage, monitor liver enzyme tests

Client teaching: wear MedicAlert® identification, avoid dangerous activity, wash hands, avoid crowds, need for follow-up care and testing, avoid alcohol


Antidysrhythmics Interventions:

Concern: new or more dangerous dysrhythmias, changes in blood pressure

maintain fluid and electrolytes balance, SaO2 >95%, sinus rhythm; assist with position changes

Monitor: pulmonary function test, ECG, blood pressure, pulse, SaO2, serum electrolytes, level of consciousness

Client teaching: ask for help to stand; report irregular pulse and technique for counting pulse, call doctor if the client develops palpitations, weakness, loss of appetite


Antiinfective agents Interventions:

Concerns: renal and hepatic dysfunction

obtain cultures before administration, verify administration guidelines, screen for renal and hepatic dysfunction, allergy, nephrotoxic or hepatotoxic drugs

Monitor: renal function tests, liver enzyme tests, jaundice, dark stool or urine, nausea and vomiting

Client teaching: report nausea, vomiting, dark stool or urine, jaundice; need for follow-up care and testing, reinforce take all medications as prescribed, report any allergic reaction, report sudden weight gain as this may indicate adverse effects on the kidney


Loop, thiazide diuretics Interventions:

Concerns: circulatory collapse, myelosuppression, fluid and electrolytes imbalance, ototoxicity

verify infusion guidelines, blood pressure, serum electrolytes, and urinary output before giving

Monitor: serum sodium and potassium, breath sounds, edema, blood pressure, urinary output

Client teaching: report palpitations, weakness, irregular pulse, decreased urinary output, temperature


Female hormones Interventions:

Concerns: thromboembolic disorders, increased risk of breast and endometrial cancer, hyperglycemia, hypercalcemia, depression, seizures

Monitor: peripheral perfusion, edema; leg pain, tenderness; serum calcium, glucose, cytology

Client teaching: report lumps and abnormal bleeding, muscle twitching


Warfarin teaching and antidote:

antidote: V. K


Avoid: EtOH/NSAIDs/electric shavers/herbal (green tea, ginseng, licorice)/V. K foods (spinach, broccoli, onions)

Wear medic alert/monitor s/s bleeding/same time daily/FU care (PT/INR/liver)


A hospitalized 8 month-old infant is receiving digoxin (Lanoxin) for the treatment of tetralogy of Fallot. Prior to administering the next dose of medication, the parent reports that the baby vomited one time, just after breakfast. The heart rate is 72 BPM. What should be the initial response of the nurse?

A: Double the next dose
B: Give the dose after lunch
C: Hold the med
D: Reduce the dose by half

C: Hold the med

Toxic side effects of digoxin include bradycardia, dysrhythmia, nausea, vomiting, anorexia, dizziness, headache, weakness and fatigue. It isn't necessary to hold the medication for infants and children if there is only one episode of vomiting. However, it is appropriate to hold the medication and notify the health care provider for bradycardia. Normal resting heart rate for infants 1-11 months-old is 100-160 BPM.


Two hours after receiving the first does of lithium (Eskalith, Lithobid), the client reports fine hand tremors. What is the nurse’s best explanation for these findings?

A: "You are probably having an allergic reaction. The medication should be discontinued."

B: "Taking lithium on an empty stomach should help minimize these symptoms."

C: "These are common and expected side effects and should subside in a few days."

D: "Reducing dietary intake of sodium and fluids should minimize any side effects."

C: "These are common and expected side effects and should subside in a few days."

Tremors are common side effects that usually subside quickly. Informing clients of these possible reactions can help them tolerate these initial difficulties, while continuing to take the drug and obtaining therapeutic effects.


At the client's request, the nurse performs a fingerstick to test the client's blood glucose and the results are 322 mg/dL. Following standing orders, the nurse administers 3 units of insulin lispro (Humalog) at 11 am. When does the nurse anticipate the insulin lispro will begin to act?

A: 12 noon

B: 1500

C: 1115

D: 1300

C: 1115

The onset of action and peak for insulin lispro, which is a rapid-acting insulin, is 10 to 15 minutes after administration. This type of insulin will peak in about 1.5 to 2.5 hours. It is designed to cover meals and lower high blood sugar readings.


The nurse is caring for a child diagnosed with seizures. While teaching the family and the child about the medication phenytoin (Dilantin), what information should the nurse emphasize?

Maintain good oral hygiene and dental care

Serve a diet that is high in iron

Administer acetaminophen to promote sleep

Omit the medication if the child is seizure-free

Maintain good oral hygiene and dental care

Swollen and tender gums occur often with use of phenytoin. Good oral hygiene and regular visits to the dentist should be emphasized. The medication should never be stopped, even if the child is seizure-free; sudden discontinuation could result in status epilepticus. Acetaminophen is not a sleep-aid and iron interferes with phenytoin absorption.


A client diagnosed with hypertension is started on atenolol (Tenormin). The nurse should instruct the client to immediately report which of these findings?

Slow, irregular pulse

Feeling tired


Decreased sex drive

Slow, irregular pulse

Most adverse effects are transient or mild for the beta-blocker, atenolol (Tenormin). All the options are potential side effects of this drug; however, the client should report bradycardia and (postural) hypotension to the health care provider.


The nurse is assessing a client with a history of hypertension. Which of these questions is a priority for the nurse to ask?

"Tell me about your usual diet for one day."

"Describe your usual exercise and activity patterns."

"What over-the-counter medications do you take?"

"Describe your family's cardiovascular history."

"What over-the-counter medications do you take?"

Over-the-counter medications (OTC), especially those that contain cold preparations, can increase the blood pressure to the point of aggravation of the hypertension. The nurse would ask the other questions, but the answers to these questions don't have as great a risk for the client as the question about OTC medications.


A 55 year-old woman is taking prednisone and aspirin (ASA) as part of the treatment for rheumatoid arthritis. Which approach would be an appropriate intervention for the nurse?

Test stools for occult blood

Assess the pulse rate every four hours

Discuss fiber in the diet to prevent constipation

Monitor the level of consciousness every shift

Test stools for occult blood

Both prednisone and ASA can lead to gastrointestinal bleeding. Therefore, monitoring for occult blood is indicated.


A nurse is caring for a client with schizophrenia who has been treated with quetiapine (Seroquel) for one month. Today the client is increasingly agitated and reports having muscle stiffness. Which of these additional findings should be reported to the health care provider?

Decreased pulse and blood pressure

Mental confusion and general weakness

Elevated temperature and sweating

Muscle spasms and seizures

Elevated temperature and sweating

Neuroleptic malignant syndrome (NMS) is a rare disorder that can occur as a side effect of antipsychotic medications. It is characterized by muscular rigidity, tachycardia, hyperthermia, sweating, altered consciousness, autonomic dysfunction, and increased creatine phosphokinase (CPK). This is a life-threatening complication.


The nurse notes that a prescription for captopril (Capoten) was changed to losartan (Cozaar), even though the captopril provided effective blood pressure control. What is the most likely reason for discontinuing the captopril?

A: Sexual dysfunction
B: Blurred vision
C: Rash and itching
D: Dry cough

D: Dry cough

Captopril is an ACE inhibitor used to control blood pressure. Some common side effects include rash, itching and blurred vision. Like many antihypertensives, ACE inhibitors can cause impotence. But a chronic cough is one of the most common and disturbing problems for clients using ACE inhibitors, prompting a change in blood pressure medication. Even after discontinuing the ACE inhibitor, it may take weeks or months for the cough to go away. Angiotensin receptor blockers, such as losartan, are often prescribed when clients cannot tolerate an ACE inhibitor.


A client with heart failure has digoxin (Lanoxin) ordered. What would the nurse expect to find when evaluating for the therapeutic effectiveness of this drug?

A: Increased heart rate with increased respirations
B: Improved respiratory status with increased urinary output

C: Diaphoresis with decreased urinary output
D: Decreased chest pain with decreased blood pressure

B: Improved respiratory status with increased urinary output

Digoxin, a cardiac glycoside, is used in clients with heart failure to slow and strengthen the heartbeat. As cardiac output is improved, renal perfusion is improved and urinary output increases. Clients can become toxic on this drug, indicated by findings of bradycardia or tachycardias above 120, arrhythmia, visual or gastrointestinal disturbances. Clients being treated with digoxin should have the apical pulse evaluated for one full minute prior to the administration of the drug.