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Pharmacology 2016 → PRIORITY ONE 1. A nurse is caring for a client who is taking phenytoin. For which of the following adverse effects should the nurse monitor and report to the provider? a. Cog... nitive impairment b. Tachycardia +. c. Elevated blood pressure d. Tinnitus Rationale: Pharmacology 7.0 Chapter 13 page 96: phenytoin (Dilantin, Phenytek) : Classification: antiarrhythmics, anticonvulsants. Pharmacologic: Hydantoins. Pregnancy category: D. Indications: treatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures via enhancing inhibitory effects of GABA and decreases neuron firing. Also used as an antiarrhythmic, particularly for ventricular arrhythmias associated with digoxin toxicity & prolonged QT interval. Adverse effects: CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairment) notify providers if these occur, Gingival hyperplasia (softening and overgrowth of gum tissue, tenderness, and bleeding gums; maintain good oral hygiene), Skin rash (stop med if this occurs), Cardiovascular effects (dysrhythmias, hypotension), Endocrine and other effects (coarsening of focal features, hirsutism, and interference with vitamin D metabolism), and Interfering with vitamin K-dependent clotting factors causing bleeding in newborns. 2. MISSING 3. MISSING 4. A nurse is teaching a client who has a history of acute myocardial infarction about taking metoprolol to treat angina. Which of the following instructions should the nurse include? a. Stop taking the medication if you become dizzy - NEVER EVER discontinue abruptly without consulting your provider b. Check your pulse rate daily - can cause bradycardia. So, you withhold the meds if HR is under 50. Also, can cause orthostatic hypo, and MASK hypoglycemic effects of insulin. c. Expect to see an increase in your urinary output d. Call your provider if you lose more than 1 pound per week Rationale: Pharmacology 7.0 Chapter 20 page 158: Metoprolol (Betaloc, Lopressor): Classification: antianginals, antihypertensives. Pharmacological: Beta adrenergic blockers (sympatholytics), cardioselective. Indication: blocks stimulation of beta1 (myocardial)-adrenergic receptors. Decreases BP, HR, and frequency of attacks of angina pectoris. Adverse effects: bradycardia (monitor pulse, if below 50 BPM, hold med), decreased cardiac output, AV block, orthostatic hypotension, and rebound myocardium excitation. 5. A nurse is caring for a client who develops an anaphylactic reaction to IV antibiotic administration. After assessing the client’s respiratory status and stopping the medication infusion, which of the following actions should the nurse take next? A. Elevate the client’s legs and feet B. Administer epinephrine IM C. Replace the solution with 0.9 % sodium chloride D. Give diphenhydramine IM Rationale Pharmacology 7.0 Chapter 5 page 36: Anaphylactic reaction: a life threatening, immediate allergic reaction that causes respiratory distress, severe bronchospasm, laryngeal edema, a quick drop in blood pressure, as well as cardiovascular collapse. Treat with epinephrine, bronchodilators, and antihistamines. Provide respiratory support, and inform the provider. 6. A nurse is assessing a client who is receiving via continuous IV infusion for labor augmentation. The nurse notes six contractions in a 10-minute period with a nonreassuring FHR. Which of the following actions should the nurse take first? a. Administer Terbutaline 0.25 mg subcutaneously b. Discontinue the oxytocin IV infusion c. Turn the client on the left side d. Apply oxygen at 10 L / min via face mask Rationale: Pharmacology 7.0 Chapter 32 page 253: Oxytocin (Pitocin): hormone, oxytocics, pregnancy category X. Uterine stimulants increase the strength, frequency, and length of uterine contractions. (contractions lasting longer than 60 secs, and occurring more frequently than every 2 to 3 min, stop the infusion, and notify the provider. Practice question from RN Pharmacology Practice Questions A: the priority question is for the nurse to place the client in lateral position. 7. A nurse is administering Lactated Ringer solution at 100ml/hr. The drop factor of the manual IV tubing is 15 gtt/ml. The nurse should set the manual IV infusion to deliver how many drops per minute? Round the answer to the nearest whole number? mL/ min x drop factor (gtt/min) 1 hr. = 60 min 100 mL/60 min x 15 gtt/mL = 25 gtt/min 8. A client who has active tuberculosis and is taking rifampin reports that this urine and sweat have developed a red orange tinge. Which of the following actions should the nurse take? page 376 Adverse effects: Hepatotoxic sxs (jaundice, anorexia, fatigue, nausea vomiting, Metabolizes, warfarin, HIV drugs. and PO contraceptives NI: give it 1 or 2 hours before or after meals. a. Prepare the client for dialysis - no need to, orange pee is expected b. Instruct the client to increase the fluid intake c. Check the client’s liver function tests results d. Document this as an expected finding - Rationale: Pharmacology 7.0 Chapter 47 page 376: Rifampin: Broad spectrum antibiotic for gram-positive and gram￾negative bacteria. Is given in combination with at least one other antituberculosis medication to help prevent antibiotic resistance. Inform clients of expected orange color of urine, saliva, sweat & tears. Adverse effects: hepatotoxicity (jaundice, anorexia, and fatigue), mild GI discomfort, and pseudomembranous colitis. Contraindicated in clients who have liver dysfunction. 9. A nurse is teaching a client about self-administration of enoxaparin . Which of the following instructions should the nurse include? (Select all that apply) a. Grasp the skin between the thumb and forefinger, while injecting the medication (SQ) b. Alternate the injection sites between the side of the abdomen c. Expel the air bubble from the prefilled syringe (do not expel the bubble) d. Massage the insertion site after injecting the medication (do not rub) e. Insert the entire length of the needle into the skin during injection Rationale: pg. 324 pharm ATI enoxaparin (Lovenox) low molecular heparin prevent clotting by activating antithrombin and indirectly inactivating both thrombin and factor x. inhibits fibrin formation. Normal aPTT levels are 60-80 seconds. 10. A nurse is caring for a client who is receiving warfarin to treat atrial fibrillation. Which of the following laboratory lab values should the nurse identify as the outside the expected range for this client? A. aPTT 36 seconds 35 - 45 seconds B. Hgb 15.2 g/dl 12- 16 C. Hct 43 % 35- 45 D. INR 4.5 normal is 2-3 seconds PT levels normal is 18-24 seconds. - Warfarin check INR and PT (18-24 seconds) - Heparin-check aPTT SUBQ. apply pressure at site after injection p .191 pdf -Effects take 8- 12 hours. avoid sitting long periods, and crossing legs. 11. A nurse is caring for a client who is receiving ondansetron IV (antiemetic--serotonin antagonist). Which of the following is an indication that the ondansetron is effective? a. Increased urinary output b. Decreased Nausea c. Absence of peripheral neuropathy d. Reduced dizziness Rationale PDF pg. 221: Prevents emesis by blocking the serotonin receptors in the chemoreceptor trigger zone (CTZ), and antagonizing the serotonin receptors on the afferent vagal neurons that travel from the upper GI tract to the CTZ. 12. A nurse is caring for a client who has a major depression and a new prescription for citalopram . Which of the following adverse effects should the nurse report to the provider? A. Confusion - serotonin syndrome can begin 2-72 hours after starting treatment and can be LETHAL. (confusion, delirium, fever, tachycardia, increased BP, hyperreflexia, diaphoresis, tremors, spasm) if any of these occur, notify provider and withhold medication… I think it’s this one over C.? B. Bruxism- grinding of teeth during sleep, which can be treated with low dose buspirone C. Weight Loss - weight gain is a sxs Rationale page 49 pdf: part of SSRI family. Used to lower anxiety, depression, OCD. SSRIS needs about 4 weeks for the drug to kick in and work. Serotonin syndrome sxs: agitation, confusion, hyperreflexia, tremors, spastic muscle contractions aka clonus. Adverse effects are: GI bleeding, hyponatremia, serotonin syndrome, suicide ideation, postural hypotension. I have this lol 13. A nurse caring for a client who has acute cocaine toxicity. The nurse should plan to provide which of the following treatments? a. Gastric Lavage b. Saline cathartic c. Naloxone→ antidote for opiates (opium, morphine, heroin, codeine, and Demerol) d. Diazepam → cocaine tox are risk for seizures, admin Rationale pg. 476 naloxone opioid antagonist treatment of opioid overdose 14. A nurse is providing teaching to a client who has diabetes insipidus and is receiving DESMOPRESSIN. Which of the following statements should the nurse include in the teaching? a. Your urine might have a reddish tint while taking this medication b. You will need to check your blood glucose every morning while taking this medication c. You can expect to have less urine output when you are taking this medication d. You will need weekly laboratory work to determine your blood clotting time Rationale page 319 antidiuretic. Desmopressin causes less vasoconstriction than natural ADH (hormone in posterior pituitary that is used to retain sodium and water.) Tiamson went over this lol. DI, they are urinating a lot. With a vasopressor, it can act as an antidiuretic and decrease the amount of urine the patient urinates. CONTRA for people with CAD, decreased peripheral circulation, can cause Headache, chest pain. 15. A nurse is teaching a client who has pernicious anemia to self￾administer nasal cyanocobalamin (vitamin B12--helps convert folic acid to active form) . Which of the following information should the nurse include in the teaching? Page 232 pdf (helps convert folic acid for DNA production. a. Plan to self-administer this medication for the next 6 months -- lifetime treatment b. Administer the medication into one nostril once per week -- daily? c. Use a nasal decongestant 15 minutes before the medication if you have a stuffy nose d. Lie down for 1 hour after administering the medication --too long, at least 5 minutes Rationale PDF pg. 135: Sympathomimetic decongestants stimulate alpha1‑adrenergic receptors, causing reduction in the inflammation of the nasal membranes. Increase dairy products for b 12. medication effects may be decreased if patient has increased nasal secretions. 16. A nurse is planning to teach a client who has gout about allopurinol (hyperuricemia--inhibits uric acid production) . Which of the following instructions should the nurse include in the teaching? a. Take after meals - to minimize GI distress, insomnia, headache, b. Take an iron supplement - may add to GI distress it may cause c. Limit fluid intake to 1 liter - always drink 2 liters of water per day. d. Increase calcium intake - may cause GI distress as well. Rationale PDF p.266: Advise clients to take oral gout medication with food or after meals to minimize GI distress. Allopurinol can cause GI distress. Rhabdomyolysis, can cause rash, avoid purine foods such as ETOH, red meat, 17. A nurse is assessing a client who has heart failure and is taking digoxin (antiarrhythmic--decrease electrical conduction through AV node; increase myocardial contraction) . Which of the following findings should the nurse identify as an early indication of medication toxicity? a. Visual disturbances b. Insomnia c. Potassium 4.4 mEq/L --within normal values 3.5-5 mEq/L d. Sudden weight gain --anorexia Rationale PDF p.177: Monitor for indications of digoxin toxicity: anorexia, nausea, vomiting, visual disturbances, dysrhythmias; Hypokalemia increases risk for toxicity 18.) A nurse is reviewing the medical record of a client who is taking clozapine (atypical anti-psychotics--blocks serotonin & dopamine receptors). Which of the following findings should the nurse report to the provider immediately? P .72 pdf a) LDL 220 mg/dL (normal value: <100 mg/dl) LDL should be < 130 MS pdf p 161 Ch. 27 b) WBC 2,500/mm3 (considered low but not an adverse effect) c) Fasting blood glucose 180 mg/dL (hyperglycemia? Not indicative of DM) Ch. 82 page 528 MS PDF … normal fasting blood glucose is < 126 d) BMI of 28 Rationale PDF p.72: High risk of weight gain, diabetes mellitus, dyslipidemia, agitation, mild eps (tremors, akathisia), elevated prolactin levels. Rationale Book p.114: Monitor cholesterol triglycerides and blood glucose if weight gain is more than 14 kg (30 lbs.) [Show More]

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