A patient asks why albuterol causes a feeling of jitteriness when it is used to treat wheezing. The nurse knows that albuterol is a beta-adrenergic agonist that acts on beta2 receptor sites to cause smooth muscle dilation in the bronchioles of the lungs, but that it also can sometimes act on beta1 receptor sites in skeletal muscles to cause tremors. To explain this to the patient, the nurse will rely on knowledge of:
a. drug selectivity.
The ability of a drug to be selective for receptor sites in a patient determines the types of effects it can have on the body. This drug can bind to two different types of receptors that cause different reactions. The modified occupancy theory addresses the strength of an attraction between a drug and a receptor and the drug's ability to activate the receptor. Relative potency describes the amount of drug needed to produce a specific effect. Most drugs remain bound to receptors permanently, causing the effects to be reversible.
A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "2 puffs every 4 hours as needed for coughing or wheezing." The patient reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which is not an appropriate nursing intervention for this patient?
Suggesting that the patient use one puff to reduce side effects
It is not within the nurse's scope of practice to change the dose of a medication without an order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate the patient's ability to administer the medication properly and is part of the nurse's evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessment helps the nurse evaluate the patient's response to the medication.
What is the purpose of the planning phase of the nursing process?
Setting priorities and developing patient goals and outcomes*
To design a plan of care for and with the patient that, once implemented , results in the prevention, reduction, or resolution of patient health problems and the attainment of the patient's health expectations as identified in the patient outcomes
What is the purpose of the implementation phase of the nursing process?
-Intended to assist the patient to achieve the stated outcomes for the nursing diagnosis that is being addressed
-Should change or affect the specific etiology of that problem
-Step of writing the nursing orders, or individualized interventions
-It is the heart of the nursing care plan
-It is derived from the etiology or R/T from the nursing diagnosis
What is the purpose of the evaluation phase of the nursing process
measure how well the patient has achieved desired outcomes during and after each intervention (involves the patient and nurse)
-identify factors contributing to the patient's success or failure
-modify the plan of care and make changes necessary based on why the current plan isn't effective
Describe how evaluation relates to the assessment, diagnosis, planning and implementation phases of the nursing process
If a goal is unmet, you must re-examine all steps of the nursing process (possibly adding to or altering any of them based on your findings)
Why would a patient receive medication through the parenteral route?
used for induction and / or maintenance of general anesthesia, inducion of amnesia, and as adjuncts to inhalation type anesthetics.
Lasix is a loop diuretic, it is used in the management of pulmonary edema and the edema associated with heart failure, liver disease, nephrotci syndrome, and ascites. It has also been used in the treatment of hypertension. Adverse effects, Hypokalemia
Prior to providing education on a new medication to a patient and family, what is the priority step of the nursing process?
When the nurse completes patient teaching on a new medication, which method will the nurse use to evaluate the patient's understanding of the information
Ask specific questions to evaluate understanding.
This drug is a dopamine replacement drug. Dopamine must be administered orally as levodopa, because exogenously administered dopamine cannot pass through the blood brain barrier. Levodopa is given in combination with carbidopa because very large oral doses of levodopa must be given to obtain adequate dopamine replacement in the brain. When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used.
How would a nurse manage break through pain?
This is administered between doses of pain medications.
A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (of a 0-10 scale) and requests "something for pain that will work quickly." The best way for the nurse to document this information is as
Correct Answer: A, Breakthrough pain
Rationale: Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.
What are the principles of neurmuscular blocking drugs such as pancuronium?
These drugs are given primarily with general anesthetics to facilitate endotracheal intubation and to relax the skeletal muscles during surgery. In addition to their use in the OR, they are given in the ICU to paralyze mechanically ventilated patients.
A pt is recovering from general anesthesia. What is the nurses main concern during immediate postoperative period
What drug is used to reverse succinylcholine?
Anticholinesterase drugs such as neostigmine, pyridostigmine, and edrophonium are antidotes and are used to reverse muscle paralysis.
What are the effects of phenobarbital?
Drowsiness, lethargy, dizziness, hangover, and paradoxial restlessness. Barbiturates deprive people of REM sleep.
Do not drink this while taking phenobarbital.
What is a narrow therapeutic level?
this range is within which the drug is effective, and above that range it is rapidly toxic.
Can Gabapentin be stopped all at once?
If discontinuation of the drug is indicated, dosage should be tapered over at least 1 week to avoid rebound seizures.
Gabapentin is a ?
may be used for seizure therapy, but it is also used to treat postherpetic neuralgia and neuropathic pain, and to prevent migranes. Drug interactions include; antacids and hydrocodone which can reduce gabapentin levels.
What to avoid while taking MAOI's
Opioid analgesics and St. Johns Wort and tyramine containing foods such as smoked meats, aged cheese, soy sauce, caffeinated drinks, chocolate and fruit.
What is an advantage of taking catechol - O- methyltransferase inhibitors while treating parkinsons disease?
They have been shown to have a greater efficacy in patients with advanced forms of Parkinsons disease. After treatment using the various dosage forms of levodopa or carbidopa - levodopa, a COMT inhibitor may then be added to the therapeutic regimen, and onset of therapeutic effects is rapid.
Entacapone normal expectation of this med?
this is a COMT inhibitor indicated for the adjunctive treatment of Parkinsons disease. Entacapone is normally taken with levodopa. Entacapone benefits patients who are experiencing wearing - off effects. Adverse effects are GI upset, dyskinesias, and urine discoloration. Caution should be used with patients with preexisting liver disease.
What is the most important to observe from a patient that has just started SSRI's for depression?
Patients should be monitored closely for serotonin withdrawal.
Should not be given to patients with coronary heart disease.
Patient education about sumatriptan (Imitrex)
treatment for migraine headaches, it is given upon the onset of headache. This drug is not a preventive migraine therapy
Contraindications: drug allergy and the presence of cardiovascular disease, uncontrolled hypertension; cerebral, cardiac, or peripheral vascular disease; dysrhythmias; glaucoma; and coronary or ischemic heart disease.
Adverse Effects of Sumatriptan
feelings of tingling, flushing, and a congested feeling in the head or chest.
Nausea, vomiting, cold or clammy hands and feet, muscle pain dizziness, numbness, and a vague feeling of anxiety, a bitter or foul taste in the mouth or throat, and irritation of the nose.
What are the therapeutic effects of Sibutramine?
Is used to treat obesity, effects are often minimal without accompanying behavioral modifications involving diet and exercise. Appetite control and weight loss for the treatment of obesity.
What can influence the effectiveness of the cimetidine (Tagamet)
should be taken 1 to 2 hours before antacids
cimetidine and famotidine should be administered simultaneously with antacids. These drugs may be spaced 1 hr apart if both drugs need to be given.
should be taken with meals.
Why and when should glycol be used?
It is a laxative and can be used before surgery or any other medical procedure. it rids the colon of fecal matter.
Patient teaching on Omeprazole (Prilosec)
This is an antisecretory drug, works best when taken 30 to 60 minutes before meals.
Must know list of current medications.
Omeprazole should be taken whole and not crushed, opened, or chewed.
Why is Mannitol (Osmitrol) used for?
Mannitol is a osmotic diuretic, used in the treatment of patients in the early, oliguric phase of acute renal failure. However, enough renal blood flow and glomerular filtration must still remain to enable the drug to reach the renal tubules.
It can also be used to promote the excretion of toxic substances, reduce intracranial pressure, and treat cerebral edema. in addition, it can be used as a genitourinary irrigant in the preparation of patients for transurethral surgical procedures and as a supportive treatment in patients with edema induced by other conditions. Mannitol is not indicated for patients with peripheral edema because it does not promote sufficient sodium excretion.
What are the side effects of pramipexole (Mirapex) that is less likely to occur with other dopamine agonist?
One side effect associated with pramipexole that is less likely to occur with other dopamine agonists is
What is a nurse expectations for a cancer patient that has anorexia from chemo and radiation for cancer that requires nutritional supplementation?
patient feeling nausea, vomiting, sores in mouth, no appetite, may need to TPN, difficulty swallowing
what should a nurse hang if a parenteral nutritional bag runs dry and a new bag has not been ordered?
5 to 10% dextrose, cause rebound hypoglycemia can occur
During the night shift, a patient's total parenteral nutrition (TPN) infusion ran out, and there was no TPN solution on hand to continue the infusion. The nurse will have to implement measures to prevent what consequences of abruptly discontinuing TPN infusions?
A woman has been receiving both radiation and chemotherapy for her cancer. Lately, she has developed anorexia caused by the treatments, so she needs short-term nutrition supplementation. The nurse anticipates that the physician will initiate which therapy?
Peripheral parenteral nutrition (PPN)
The peripheral parenteral nutrition bag that has been infusing into an assigned patient has run dry before a new bag has been ordered. The nurse should immediately hang with of the following available solutions until the new bag arrives?
10% dextrose in water
Why would a patient be receiving allopurinol (Zyloprim) when the patient is already receiving cyclosporine (Neoral)?
To prevent uric acid production
What are the advantages for a patient to take captopril (Capoten) with severe liver disease?
Pro-drugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective. Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are pro-drugs
Signs and symptoms of hypersensitivity reaction?
Also know as allergic reaction, skin erythema, mild rash to severe, constriction of bronchial airways and tachycardia. vomiting and abdominal pain.
What medication is first line treatment for hypertension patients
How beta blockers decrease blood pressure?
Beta blockers lower the heart rate. ARB's work by blocking the binding of angiotensin at the receptor; the end result is a decrease in blood pressure.
Why would a patient be taking multi -drug therapy for hypertension?
Resistant Hypertension; two drugs work better to lower blood pressure.
Signs and symptoms of Ketoacidosis
confusion, abdominal pain
dry skin, mouth
increased heart rate
low blood pressure
fruity odor on breath
What is the appropriate action when administering amphotericin B (Fungizone)
intravaneous amphotericin B, solutions that are cloudy or have precipitates should not be administered, IV pump is recommended, vital signs should be monitored every 15 minutes, IV site should be monitored for signs of phlebitis
A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. Which of the following should the nurse include in the teaching plan for this patient?
Taking the medications with food reduces gastrointestinal upset.
Teaching plan for Retin - A
is a derivative of vitamin A that is used to treat acne and ameliorate (fine wrinkling, mottled hyperpigmentation,roughness) with photodamage.
Patients should maintain adequate general hygiene
avoid abrasive cleaners
Retin - A also treats leukemia
What is the length of time a patient will be treated for fungal infections?
fungal infections are present in the mouth, vagina, and intestinal tract. Periods of treatment can range from several weeks to as long as 1 year. Most common adverse effects of topical antifungals are local irritation, pruritus, a burning sensation, and scaling.
The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
Choose one answer.
. Parenteral drugs bypass the first-pass effect.
patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers should the nurse give to the patient?
Choose one answer.
The bronchodilator should be taken first."
When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse should discuss which potential problem?
75-year-old woman comes into the clinic with the complaint of indigestion, stomach pain, and frequent belching. She tells the nurse that she has been taking sodium bicarbonate 5 or 6 times a day for the past 3 weeks. The nurse knows that which possible hazard exists with the use of sodium bicarbonate?
. Metabolic alkalosis may result from excessive use.
What is cytotec and what is the benefit of taking them with NSAID's?
Cytotec has been shown to reduce the incidence of gastric ulcers in patients taking NSAID's. Cytotec is thought to inhibit gastrica acid secretion. They are believed to protect the gastric mucos from injury.
What is the disadvantage of self - treatment for heartburn?
changes in systemic PH
Why would a patient take 81mg of aspirin a day?
To keep blood thin
prevent thrombosis formation
used as a prophylaxis against transient ischemic attacks.
used to treat angina pain
In patients with severe bone marrow supression, the nurse be knowledgeable of what principal early signs of infection?
* fever- greater than or equal to 100.5 degrees F
* Chills or shakes
* Sudden onset of unexplained pain
What age is a DTap is given
Pediatric only - age of first injection 6wk-7yr; give second and third doses at 4-8 wk intervals. ages are 2,4,6, and 15 yrs.
What are the contraindications of oral laxatives?
impaction above strictures
adverse effects of dry mouth may be helped by frequent mouth care, fluid intake, or use sugarless gum or candy.
What are the interventions for administering interferon (Actimmune) drugs?
adverse effects include: flu - like symptoms, fever, headache, malaise, myalgia, and fatigue. the major dose limiting adverse effect is fatigue
Used for the treatment of viral infections, various cancers, and some autoimmune disorders.
patients CBC should be documented, because long term therapy with these drugs may lead to bone marrow suppression. other levels should be checked like BUN, creatinine levels, platelet counts, and ALP and AST, and UA.
baseline vital signs.
While assessing a patient who is receiving intravenous digitalis, the nurse recognizes that the
drug has a negative chronotropic effect. How would this drug effect be evident in the patient?
Choose one answer.
Decreased heart rate
Why would a patient have to receive digoxin immune Fab (Digibind)?
Should toxicity occur and digoxin rise to a life-threatening level, the antidote, digoxin immune fab, should be administered. It is given parenterally over 30 minutes, and in some scenarios it is given as an intravenous bolus. Digoxin levels are 0.5 -2
In assessing a pt before administration of cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
a. K+ level of 2.8
What does the "cheese effect" result in ? (Selegiline)
This drug interacts with tyramine - containing foods such as (cheese, red wine, beer, and yogurt) because of their inhibitory activity against MAO-A. And one hazardous result can be hypertension.
What are the recommendations for a patient taking Warfarin (Coumadin) and wants to take a pain reliever for a headache
Take acetaminophen (Tylenol) avoid NSAID's
Nurses instructs a patient who is ordered ocular cyclosporine (Restasis) and an artificial tears product.
Use the Restasis first,then use the artificial tears
When would a patient be likely to see a change in his serum cholesterol when taking statin drugs?
When these drugs are taken, lipid levels may not be lowered to their maximum extent until 6 to 8 weeks after the start of therapy.
Patient teachings on Allegra
When Allegra is given with erythromycin, increased fexofenadine concentrations can result. Its an antihistamine that is given to relieve the symptoms of the common cold, sneezing, and runny nose, and treatment for allergies. Reduces salivary, gastric, lacrimal, and bronchial secretions. They are used for motion sickness, Parkinsons disease, and vertigo.and sometimes used as a sleep aid. Allegra is not recommended for children under the age of 6 yrs or those with renal impairment. Caution should be addressed in patient with impaired liver function or renal insufficiency as well as lactating mothers.
Why would pramoxine be added to an otic medication?
to help ease pain and itching common in ear infections.
When would a patient receive folic acid treatment that is newly diagnosed with anemia?
A patient must be determined anemic before starting folic acid treatment. and it should be emphasized that folic acid should not be used to treat anemias until the underlying cause and type of anemia have been determined.q
What is the most reliable measure for assessing diabetes control over a 3 - month period?
Fasting plasma glucose
prescribers order for insulin must be assessed, so that the correct drug, route, type of insulin and dosage are implemented correctly.
What is the most reliable measure for assessing diabetes control over a 3 - month period? cont.....
Another important caution to emphasize is the need to monitor liver function by reviewing ALT levels before drug therapy is initiated and periodically thereafter, such as every 3 months as ordered.
What is a concern with Afrin nose drops when they are stopped suddenly?
could cause damage to your nasal tissue and lead to chronic congestion. (rebound congestion in which the nasal passages become more congested as the effects of the drug wear off.)
What is a nurses, immediate concern for a patient that is on dobutamine (Dobutex) drip for heart failure that has been feeling better but now has tightness in the chest, palpitations, as well as a bit of anxiety?
careful titration and monitoring of vital signs and ECG are required. Patient could be in toxic overload
Patient teaching for a patient that has been ordered atenolol (Tenormin)
This bet blocker is commonly used to prevent future heart attacks in patients who have had one. it is also used in the treatment of hypertension and angina. Apical pulse should be counted for one full minute and both supine and standing blood pressures should be measured and documented. Patients should weight themselves daily, avoid sudden changes in position, and increase fluids and fiber. Alcohol should be avoided.
Your patient is receiving dobutamine as a continuous infusion. Titration of this medication is based upon which factors? (Select all that apply.)
A) Heart rate
B) Blood pressure
C) Urine output
patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, "I don't understand why this is not working. I am using it almost every 3 hours!" The nurse's response is based on knowledge that
) the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray.
A PATIENT IS GOING HOME WITH A NEW PRESCRIPTION FOR THE BETA-BLOCKER ATENOLOL. the NURSE SHOULD INCLUDE WHAT CONTENT WHEN TECHING THE PATIENT ABOUT THIS DRUG?
be WATCHFUL FOR THE FIRST-DOSE HYPOTENSION
A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor), and he becomes upset. "I don't have high blood pressure-why did my doctor give me this medicine?" The nurse explains to him that
Choose one answer.
studies have shown that this medication has greatly increased survival rates in patients after an MI.
Why would a patient be administered an anticholinergic medication pre - operative?
to reduce secretions
Patient teaching on tamsulosin (Flomax) that is taking it to reduce urinary obstruction due to BPH
Adverse effects include: headache, abnormal ejaculation, rhinitis.
Interacting drugs include: alpha blockers, calcium channel blockers and erectile dysfunction drugs.
This drug must be taken as directed and with cautious use by patients with by patients with blood pressure problems. This drug should also be used with caution by the elderly and while driving or engaging in other activities requiring alertness, because the adverse effects of this drug include blurred vision, dizziness, and drowsiness.
A client is given tamsulosin (Flomax) for benign prostatic hyperplasia (BPH). The nurse knows that the action of this drug is due to selective blockade of which one of the following receptors?
How long does donepezil (Aricept) take to see improvement when taking this medication?
It could take up to 6 weeks for therapeutic results.
Nurse prepares teaching plan regarding administration of eardrops for parents of 2 yr. old child. Which would be included?
Pull earlobe down and back before instilling eardrops.
R: When administering eardrops to child who is less than 3, ear s/be pulled down and back. For children who are more than 3, ear is pulled up and back. Hand washing needs to be performed before and after procedure. Child s/be in a side-lying position w/the affected ear facing upward to facilitate flow of medication down ear canal by gravity.
A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer's disease. Her daughter calls the physician's office and is upset because "Mother has not improved one bit!" Which response by the nurse is appropriate?
. "It may take up to 6 weeks to see an improvement."
The nurse is about to administer a stat dose of atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse should monitor the patient closely for which adverse effect?
The nurse should instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur?
After receiving a nebulizer treatment with a beta-agonist, a patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response?
A. "This is an expected adverse effect. Let me take your pulse."
Patient teaching on nasal sprays
Patient should be instructed to report excessive dizziness, heart palpitations, weakness, sedation, and / or excessive irritability to the prescriber.