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1

Pilocarpine eye drops, need for further teaching?
a. I will not drive for a while after I put the drops in
b. I know this med can cause local eye pain
c. I will stop using the drops as soon as my vision improves
d. i know this med can cause SEs in other areas of the body

c. I will stop using the drops as soon as my vision improves. Pilocarpine is used to tx open-angle glaucoma, a chronic condition w/progressive optic nerve damage w/eventual loss of vision. Pilocarpine indirectly reduces intraocular pressure by facilitating aqueous humor outflow and is used for long-term management. Ps should not drive as pilocarpine causes miosis (constriction) which decreases visual acuity. The med can also cause local eye pain or be absorbed systemically (causing bradyc, hypotension, bronchospasm, diarrhea, diaphoresis).

2

Med hx for new Rx for allopurinol. Wotf meds will have a potential interaction?
a. Colchicine
b. Omeprazole
c. Nifedipine
d. Warfarin

d. Warfarin. Allopurinol is used to tx gout by reducing uric acid levels. The med works by inhibiting xanthine oxidase (which is an enzyme required for uric acid formation), thus reducing the formation of tophi and allowing join function to improve. Allopurinol inhibits hepatic drug-metabolizing enzymes, thereby delaying the inactivation of other drugs, thus p's on warfarin should have their dosage reduced.

3

Functions of the parasympathetic nervous system

slowing of HR, increased gastric secretions and motility, emptying of the bladder, focusing the eye for near vision, constricting the pupil (miosis), and contracting bronchial smooth muscle (bronchoconstriction)

4

Functions of the sympathetic nervous system

Regulating the CV system, body temperature, and innervating the fight-or-flight response. These processes mean an increased HR/BP, shunting of blood away from (vasoconstriction) or towards (vasodilation) the skin and to skeletal muscles, dilating the bronchi to improve oxygenation, dilating the pupils (mydriasis), mobilizing stored energy, thereby providing glucose for the brain and fatty acids for muscles.

5

Alpha-1 receptors of SNS

Alpha 1 receptors are located in the eyes, blood vessels, male sex organs, prostatic capsule and bladder. Activation of ocular receptors leads to mydriasis, blood vessel receptors lead to vasoconstriction, in male sex organs activation causes ejaculation, activation in bladder and prostatic receptors causes contraction of sphincter muscles.

6

Alpha 2 receptors of SNS

Alpha 2 receptors are located on presynaptic nerve terminals, not on organs, thus they regulate NT release. When too much NE is secreted into the synaptic space, the Alpha 2 receptor can be activated by the NE and the outflow of further NE hormone will be stopped. This is a feedback loop mechanism

7

Beta-1 receptors of the SNS

Beta 1 receptors are located in the heart and kidneys. Cardiac beta-1 receptor activation causes an increased HR, increased contractility, and increased velocity of impulse contraction through the AV node. Kidney B-1 receptor activation causes renin release, leading to the synthesis of angiotensin and subsequent vasoconstriction. Thus, Beta-1 receptors help to elevate BP

8

Beta-2 receptors of the SNS

Beta-2 receptors are located in the heart, lungs, skeletal muscles, uterus, and liver. When activated, they respectively cause vasodilation, bronchodilation, enhanced muscle contractions, relaxation of uterine smooth muscle, and promote glycogenolysis in the liver, leading to increased BS levels.

9

While caring for a p. taking enalapril and spironolactone for HF, wotf should the RN plan to mon. for?
a. hypokalemia
b. hyperkalemia
c. hypocalcemia
d. hypercalcemia

b. hyperkalemia. Enalapril is an ACE-inhibitor that can potentially increase K+ levels, while spironolactone is a K+ sparing diuretic. In combination, these drugs should be used cautiously to prevent hyperkalemia. These drugs should not be used with ARBs or aldosterone antagonists either, as they can also promote K+ retention. P's should be instructed to avoid K+ supplements as well as salt substitutes

10

Caring for liver transplant p. taking cyclosporine. WOTF lab findings indicates an AE?
a. WBC 8000/mm3
b. Serum creatinine 2.5mg/dL
c. Serum sodium 138 mEq/L
d. Platelet count 150,000

B. Serum creat. 2.5. Cyclosporine is a powerful immunosuppressant and drug of choice to prevent transplant rejection. It does not cause bone marrow suppression, rather, the most common SEs are nephrotoxicity and infection. Other common SEs include htn, tremors, and hirsutism

11

A p. informs the RN that he has a new Rx for timolol to tx glaucoma. WOTF in the p's history should concern the RN?
a. the p. received levofloxacin for pneumonia
b. the p. has had conjunctivitis
c. the p. has a history of bradycardia
d. the p. reports that he is taking loratadine for allergies

c. the p. has a hx of bradycardia. Timolol is a nonselective beta-blocker that decreased aqueous humor production, thereby reducing IOP. Blockade of beta-1 receptors in the heart can lead to bradyc, and AV heart block, therefore beta-blocker use is CI'd for ps with a hx of these hrt problems. Likewise, beta-2 blockade in the lungs can cause bronchospasm.

12

RN caring for p. w/myasthenia gravis and is in a cholinergic crisis. WOTF should the RN give?
a. naloxone
b. flumazenil
c. atropine
d. protamine

c. Atropine. P's w/ myasthenia gravis are given neostigmine or other reversible acetylcholinesterase-inhibitors to prevent the breakdown of acetylcholine, improving skeletal muscle contractions. Toxic doses, however, cause excess ACh activity and neuromuscular blockade (respiratory paralysis). Atropine is a muscarinic antagonist, which prevents ACh from binding to these receptors, thus remedying the blockade. Naloxone is for opioid OD, flumazenil is for benzodiazepine OD, and protamine is for heparin OD

13

RN finds that a p., who is receiving morphine IVPB, has shallow resps at a rate of 8/min. After stopping the infusion, the RN should?
a. monitor the p's resps
b. administer naloxone
c. place the p in a supine position
d. monitor the p's pain level

b. administer naloxone. The next appropriate action is to give the opioid antagonist to alleviate CNS/resp depression.

14

P. receiving chemo and taking epoetin afla. WOTF lab tests will determine TE of this med?
a. bilirubin
b. albumin
c. prothrombin time
d. hemoglobin

d. hemoglobin. Epoetin alfa is used for p's with anemia to stimulate red bone marrow and increase the production of RBCs. An increase in RBC production would yield a higher level of hemoglobin, the O2-carrying iron compound.

15

RN preparing to give allopurinol to p w/gout and finds that atenolol was given, in error, on the previous shift. RN's 1st action?
a. obtain the p's BP
b. Contact the p's HCP
c. inform the charge nurse
d. Complete an incident report

a. obtain the p's BP. The first action is to monitor for SEs experienced by the patient. The next action is to inform the charge nurse and HCP, and finally complete an incident report.

16

RN plans to give amoxicillin/clavulanic acid to a p. when the p. states she is allergic to penicillin. RN's first action?
a. update the p's EMR
b. notify the HCP
c. w/hold the med
d. inform the pharmacist of the allergy to penicillin.

c. w/hold the medication. Amoxicillin is a broad-spectrum penicillin, thus in order to prevent an allergic rxn the RN should w/hold the med. The RN should then update the p's EMR and inform the pharmacist of the allergy.

17

RN caring for p. w/UTI and RN anticipates a Rx for ciprofloxacin. WOTF indicates a CI?
a. I have tendonitis, so I haven't been able to exercise
b. I have been a preschool teacher for 3 years
c. I take medicine for my thyroid
d. I am allergic to sulfa

a. "I have tendonitis so I haven't been able to exercise." Ciprofloxacin is a broad spectrum (bactericidal) fluoroquinolone used to tx most UTIs and enteritis. SEs of cipro include GI effects (n/v, diarrhea), CNS effects (dizz, h-ache), phototoxicity (severe sunburn), and tendon rupture. Tendon rupture can occur as fluoroquinolones disrupt the extracellular matrix of cartilage, thus, the drug is d/c'd at the 1st sign of tendon pain or swelling.

18

Teaching r/t trimethoprim/sulfamethoxazole should include?
a. chew tablets thoroughly
b. take in the evening
c. drink 8 to 10 glasses of water daily
d. rise slowly from the bed in the morning

c. drink 8-10 glasses of water/day. TMP/SMZ is a sulfonamide antibiotic that works by inhibiting bacterial folic acid synthesis, which stops DNA replication. It is most commonly used to tx UTIs. AEs include steven-johnson syndrome, blood dyscrasias, kernicterus (in NBs), and crystalluria. Sulfonamides have low solubility and can precipitate out of urine to form crystals in the urinary system, causing obstruction/irritation. To minimize this risk, adults should maintain adequate I&O

19

Methylphenidate for ADHD in school age p. WOTF indicates that interventions to minimize AEs were successful?
a. increase in BP
b. maintains age-appropriate wt.
c. increase in energy level
d. maintains pretherapy ability to focus

b. maintains age appropriate weight. A SE of all CNS stimulants is appetite suppression. To prevent cachexia and malnutrition, the child's wt should be monitored

20

Teaching r/t NPH insulin and regular insulin administration in the same syringe. RN should instruct the p. to take these steps in what order?
a. insert air into the NPH insulin into the syringe
b. insert air into the regular insulin into the syringe
c. draw up the NPH insulin into the syringe
d. draw up the regular insulin into the syringe

b. insert air into the NPH insulin vial.
a. insert air into the reg insulin vial.
d. draw up the reg insulin into the syringe
c. draw up the NPH insulin into the syringe

(acute before chronic, short before long)

21

WOTF instructions should be given to a p. and family r/t Rx for fentanyl patches q72hr?
a. the HCP will Rx naloxone at home for resp depression
b. a stool softener should be taken on a daily basis
c. increased UOP should reported to the HCP
d. removing the patch will reverse the AEs within a few minutes

b. a stool softener should be taken on a daily basis. Transdermal fentanyl has the same AEs as other opioids and p's should be instructed on how to manage them. Naloxone is only given in the hospital via IV. Urine retention, rather than polyuria, is an AE r/t morphine. AEs may persist for hours following patch removal owing to continued absorption from the skin.

22

WOTF indicates the TE of pegfilgrastim in a p. w/cancer?
a. increased WBC count
b. increased Hgb
c. increased platelets
d. increased K+ level

a. increased WBC count. Pegfilgrastim is a leukopoietic growth factor used to stimulate bone marrow and increase the neutrophil count in p's who have immunosuppression (often r/t chemo). AEs of pegfilgrastim include bone pain, leukocytosis, splenomegaly and splenic rupture with long term use (LUQ pain). P's need CBC labs drawn q2weeks

23

WOTF teachings should be included for a prefilled epi injector?
a. administer the med subcutaneously
b. massage the site for 10 seconds after injection
c. expect to administer three injections
d. store the auto-injector in the fridge

b. massage the site for 10 seconds after injection. Massaging the site promotes absorption of the drug. Other instructions include administering the drug intramuscularly, expect to administer one injection, then another if bronchospasm is untreated, and store the injectors at room temp. in a dark place.

24

Lab results to monitor for the p. taking zidovudine?
a. magnesium
b. serum albumin
c. serum creatinine
d. hemoglobin

d. Hgb. Zidovudine - Retrovir is used to decrease HIV symptoms by inhibiting DNA synthesis and viral replication. AEs include bone marrow suppression (thus anemia), lactic acidosis, n/v, diarrhea, and hepatomegaly. The RN should monitor CBCs and give epoetin alfa for p's that develop anemia

25

Instructions for p. w/ new Rx for captopril?
a. take with food
b. consume foods low in tyramine
c. increase fiber intake
d. change positions slowly

d. change positions slowly, ACE inhibitors can cause ortho hypotension, which is usually confined to the 1st dose. Other instructions include taking the drug 1 hour AC to promote absorption. ACE inhibitors do not cause constipation or interact with tyramine

26

Postop p. has received hydromorphone IV boluses q2h. WOTF findings should the RN attend to 1st?
a. constipation
b. hypotension
c. weakness
d. nausea

b. hypotension. ABC priorities- hydromorphone can cause CNS depression (leading to bradyc and hypotension) coma, and respiratory depression.

27

RN should assess a p. on long-term prednisone txmt for wotf AEs?
a. edema
b. hypoglycemia
c. weight loss
d. drowsiness

a. edema- glucocorticoids can cause sodium and fluid retention, as well as hypokalemia. Educate p's about fluid retention and signs of hypokalemia (muscle weakness, irregular pulses, cramps). Other AEs include hyperglycemia (diabetic p's need higher doses of insulin/hypoglycemic agents), osteoporosis, adrenal insufficiency (Cushing's), infection, and peptic ulcer disease.

28

Monitor for wotf AEs in a p. taking diphenoxylate/atropine?
a. increased salivation
b. abd distention
c. tinnitus
d. petechiae

b. abd distention- Diphenoxylate/Atropine, or Lomotil, is used to slow GI motility, increase Na+ and fluid absorption in the intestine, and prevent diarrhea. Other AEs include blurred vision, dry mouth, urine retention and constipation (anticholinergic effects of atropine).

29

Teaching p. with rheumatoid arthritis and new Rx for methotrexate. WOTF indicates understanding?
a. I should feel better in about a week
b. I will take this med each morning at breakfast
c. I should call my doctor if I develop sores in my mouth
d. I will have difficulty sleeping when I take this med

c. Sores in the mouth is a sign of stomatitis, indicating toxicity. Methotrexate is an immunosuppressant that slows joint degeneration. AEs include infection, hepatic fibrosis, bone marrow suppression, fetal death, and ulcerative stomatitis

30

Txmt for opioid addiction?
a. bupropion
b. disulfiram
c. methadone
d. modafinil

c. methadone. Bupropion is used to tx nicotine addiction. Disulfiram is used to tx alcohol addiction, and modafinil is used to tx methamphetamine addiction.