1. Discuss the use of metered-dose inhalers (MDIs) and the sequencing of medications. (Probably the following quiz question from 10/18.) Metered dose inhaler instructions for asthmatic pt? Answer: An interval of at least _____ should separate the first puff from the second.
Bronchodilation (p 897)
2a. Mode of action of theophylline (Elixophyllin.)
Mild toxicity (serum above 20 mcg/mL) nausea, vomit, diarrhea, insomnia. Serious toxicity (above 30 mcg): v-fib, convulsions. (p 897)
2b. Side effects and adverse effects of theophylline (Elixophyllin.) Answer in terms of mild toxicity to serious toxicity.
Intranasal glucocorticoids. (Example: fluticasone, Flonase. p 908)
3. What would be most effective for treating seasonal and perennial rhinitis?
Start using intranasal glucocorticoid one week before d/c the decongestant. (p 909)
4. When using an intranasal sympathomimetic for allergic rhinitis, how is the drug discontinued?
Do not use sympathomimetics (decongestants like phenylephrine, pseudoephedrine--they cause vasoconstriction p 910).
5. In a patient with a history of angina, what is safest drug for allergic rhinitis? (Answer this in terms of which group of drugs should NOT be used.)
furosemide--Lasix. (Answer from a quiz.)
6. A nurse is caring for an obese patient who is 3 days postoperative. Upon assessment, the nurse discovers that the patient is short of breath, has respirations of 32/minute, and is coughing up pink, frothy sputum. The nurse should anticipate the administration of which medication?
Low K+, below 3.5 (mEq/L, p 447 & 526)
7. A patient has been taking furosemide (Lasix) for 6 months. A prescriber has just started the patient on digoxin (Lanoxin). What assessment data should most concern the nurse prior to the administration of digoxin?
Blocks receptors for aldosterone in CV system. Aldosterone has harmful effects on CV system. (p 520)
8. A nurse is discussing the mechanism of action of spironolactone (Aldactone) with a group of nurses. The nurse states that spironolactone has been demonstrated to prolong survival as well as improve heart failure symptoms by what actions?
Limit alcoholic drinks, take in Evening (lovastatin with evening meal).
Maximal reduction of LDLs occurs in approximately 4-6 weeks.
9. -The nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?
Monitor prothrombin time; Coumadin dose may need reduction. (Gemfibrozil displaces warfarin from plasma albumin, which causes increased anticoagulant effect. P 573)
10. The nurse is reviewing the patient's medication and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. What finding concerns the nurse prior to administration?
Review baseline liver function test results. (From quiz)
11. The prescriber has ordered rosuvastatin (Crestor) for a patient with non-alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse prior to administration?
Antibiotics kill off normal flora, allowing Candida albicans (thrush) to grow into a suprainfection. (p 1007)
12. The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. Which of the following describes the etiology of the thrush?
Obtain C&S (culture & sensitivities), ask about allergies.
13. The nurse is caring for a patient on a medical-surgical unit who has been experiencing fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Take with full glass of water 1 hr ac or 2 hr pc. Finish full course of meds. (p 993, 994)
14. A patient has just received a prescription for a 10-day course of penicillin for the treatment of strep throat. What patient education is essential for the nurse to provide?
Extended spectrum when combined.
15. The patient's prescriber has ordered antibiotic combination therapy. The patient asks the nurse why two antibiotics are required. What is the benefit of combination therapy?
Toxic to microbes, but not the host. (p 970)
16. The nurse, who is teaching a pharmacology refresher course to a group of nurses, is discussing selective toxicity, what is the significance of this?
Blocks gastric acid production. (It's a proton pump inhibitor. P 921).
17. The nurse is discussing the mechanism of action of omeprazole (Prilosec) with a group of nursing students. What is the mechanism of action of omeprazole?
H. pylori, NSAIDs, smoking.
18. The nurse has provided education on factors that contribute to ulcer formation to her patient diagnosed with peptic ulcer disease (PUD). What must be included in patient teaching?
*Quiz question, select all that apply.*
Can turn tongue and stool black. (Harmless).
19. -A patient is placed on a multidrug regimen that includes bismuth (Pepto-Bismol) for treatment of peptic ulcer disease. The nurse should include what points when providing patient education?
Contraindicated: ETOH, pregnancy.
Side effects: headache, nausea, dark urine. (p 918, 1160)
20. -When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, what must be included in patient education?
Creates a (mucosal) protective barrier against pepsin and acid. (p 917, Quiz question)
21. -The nurse is providing patient education to an elderly patient being treated for duodenal ulcers. The prescriber has ordered sucralfate (Carafate). The patient asks the nurse how sucralfate helps heal ulcers. What is the nurse's response?
Antacids effect dissolution & absorption of many drugs, including Zantac. Allow 1 hour between taking antacids and other drugs. (p 925)
22. -The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the patient about taking the medications?
ondansteron--Zofran, an anti-emetic (p 925)
23. -A patient comes to the emergency department complaining of nausea, vomiting, and abdominal cramps. The nurse anticipates that the patient should receive what treatment?
Increase Fluid Intake. (MOM pulls water into bowels, can cause dehydration. p 933)
24. -What information would be most important for the nurse to provide to a patient requesting a prn dose of magnesium hydroxide (Milk of Magnesia)?
Must be taken w/ full glass of water to prevent esophageal obstruction, SBO. (Small Bowel Obstruction, p 931)
25. -A patient admitted to the unit for dehydration tells the nurse that he has not had a bowel movement in 5 days, and he typically has one daily. The nurse administers psyllium (Metamucil) as ordered and should monitor the patient for what side effect?
Serotonin Receptor Antagonist (-setron) esp. Ondansetron (Zofran)
26. -The nurse on an oncology unit is caring for a patient with lung cancer. Prior to the next dose of cisplatin (Platinol-AQ), which antiemetic would the nurse most likely administer to the patient?
dexamethasone--Decadron (Quiz question)
27. -The nurse is caring for a patient who is receiving chemotherapy. The patient complains of nausea and begins to vomit. The nurse administers ondansetron (Zofran) to alleviate the nausea. Which medication given concurrently with ondansetron would increase its effectiveness?
pt w/ hx of psychiatric disorder (Quiz question)
28. -The nurse is preparing to administer Dronabinol (Marinol) to a newly admitted patient. Prior to administration, the nurse reviews the patient's health history. Which patient would you need to question this medication?
Side effects of too much opiates/atropine. (Possibly constipation?)
29. -The nurse is preparing to administer Diphenoxylate (Lomotil) to a patient who complains of Diarrhea. For what side effects would the nurse observe the patient after administration of this medication?
Rapid-acting: lispro--Humalog. (quiz question, 11/15).
30. A patient with type I diabetes is eating breakfast at 0730. Blood sugars are on a sliding scale and are ordered AC and HS. The patient's blood sugar level is 317 mg/dL. What type of insulin should the nurse prepare to administer?
Hyperglycemia & Hypoglycemia. (p 658)
31. What are short-term complications of diabetes?
See MD only if had been fasting 8 hours prior to test.
(Fasting plasma glucose between 100 and 125 mg/dL would indicate prediabetes. p660)
32. An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's response?
33. What is the most reliable measure for assessing diabetes control over the preceding 3-month period?
Clear before Cloudy (NPH).
34. A patient with type I diabetes reports mixing NPH and regular insulin to allow for one injection. How should the nurse instruct the patient?
(AKA Lantus) Once a day at hs (bedtime).
35. Insulin glargine is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug?
Only type given IV: rapid acting (Humalog, Novolog, or Apidra p 669).
36. A patient in the ICU requires intravenous insulin. The nurse will prepare what type of insulin?
Obese pt or family hx of DM.
37. Which patient has the highest risk for type II diabetes (DM)?
IV Regular Insulin?
38. An operating room nurse prepares a patient with type II diabetes for surgery. Which type of insulin will the surgical nurse have available?
Replacement therapy is lifelong. Take med in AM at least 30 min ac.
39. A nurse is providing education for a patient beginning thyroid replacement therapy for hypothyroidism. What information provided by the nurse is most important?
Assess for hypothyroidism, check BG if pt has DM (diabetes). (p 709)
40. The nurse has just received report and is assuming care of four patients. What are the priorities of the nurse taking care of the patient receiving human growth hormone?
Advise to wait for growth spurt. Must be among shortest 1.2% of their peers to qualify for treatment. (p 704)
41. The mother of an 11-year-old is concerned because her child is not as tall as the other children in the class, and she requests that the child be treated with growth hormone. What response should the nurse provide regarding the indications for GH treatment in children?
Menstrual cycle. FSH acts on the ovaries to promote follicular growth & development. LH promotes ovulation & formation of the corpus luteum. (p706)
42. The gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), are involved in which functions in women?
Ability to treat viral infections with drugs is limited. (Quiz question)
43. A public health nurse is providing education on antiviral medications to a group of medical-surgical nurses. What information about non-HIV antiviral drugs would demonstrate an understanding on these types of drugs?
No cure, only reduces Sx. Must use condom even when lesions not present.
44. -The nurse is providing education to a patient with recurrent herpes simplex genitalis. What information must be included in patient education?
(Flu like symptoms also in occur in about 50% of pts. p 1072)
45. The nurse is providing patient education for a patient who is to start taking interferon. What is the most adverse effect of this drug?
Protection begins 1-2 weeks after vaccination, last 4 months in elderly, 6+ months in younger people.
46. An elderly patient who lives alone in the community is concerned about recent exposure to the flu and asks for an influenza vaccination. What patient education should the nurse provide?
Most effective if started within 48 hours of Sx. Take 3x day for 1 week.
47. -A patient comes to the sexually transmitted disease (STD) clinic and receives valacyclovir (Valtrex) for a herpes-zoster virus. When should the nurse instruct the patient to take the medication?
Hyperglycemia (quiz question, 11/29)
48. After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings are consistent with what sign and symptoms?
Diet & Exercise. AVOID lovastatin & simvastatin--can accumulate to dangerous levels. (P 1100)
49. The nurse is caring for a patient on a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. How will the provider manage these levels?
The toxicity of anticancer drugs to normal tissues. (Quiz question 11/29)
50. The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which factors would be a major obstacle to successful chemotherapy?"
Continue to monitor neutrophil count carefully in case it continues to drop (below 500). (Quiz question 11/29)
51. A nurse is evaluating a patient who is receiving outpatient chemotherapy. The nurse checks the patient's neutrophil count and notes that it is 900 cells/mm3. What intervention by the nurse would be most appropriate?
platelet infusion (normal range 150-350, Quiz question 11/29)
52. The nurse is caring for a newly admitted patient who has been receiving chemotherapy as an outpatient. The nurse notes that the patient's gums and nose are bleeding. Laboratory test results confirm severe thrombocytopenia. What will the nurse expect the prescriber to order?
pt w/ fever of 100 F. (But pt with nausea & vomiting is important--quiz question 11/29.)
53. Based on an in-patient oncology unit, who will the nurse see first?
Has sedative effects. Use w/ caution, especially driving, heavy machinery, and other sedatives like alcohol. (p 1271)
54. The nurse is caring for a patient who would like to try a natural alternative to help alleviate some anxiety. The patient tells the nurse, "I plan to start taking valerian. I think it will relieve some of my anxiety." What patient education is essential for the nurse to provide?
Can't claim to diagnose, treat, cure, or prevent any disease. However, can insinuate specific benefits. (P 1262)
56. What is true about herbal supplement labels?
Fatal serotonin syndrome. This adverse interaction occurs with antidepressants. (St. John's wort also decreases effects of many important drugs incl. oral contraceptives, digoxin, coumadin, antivirals, etc. p 1270)
57. The nurse is obtaining a health and medication history from a patient. The patient discloses daily use of St. John's wort in addition to prescription drugs. What effects of this drug would most concern the nurse?
Increased risk of bleeding in pts taking antiplatelet (aspirin) or anticoagulants (Coumadin, heparin). (p 1267)
58. The nurse is performing the preoperative history for a patient admitted for abdominal surgery when the 52-year-old patient states that she takes ginger root daily. Why should the nurse place an immediate call to the surgeon?
Infusion reactions within 1-3 hours: fever, chills, rigors, nausea, headache. Kidney damage: monitor I & O, want creatinine level to stay below 3.5. (p. 1058)
61. A patient has been receiving amphotericin B (Fungizone) for systemic mycoses. The nurse most likely would monitor for which signs and symptoms in this patient?
Elderly women in SNFs. (p. 1032)
62. A public health nurse is conducting research to reduce the occurrence of urinary tract infections (UTIs) among the public. What patients would have the highest risk for developing a urinary tract infection?
Sx of ototoxicity. C/o tinnitus = impending damage to cochlear. Or C/o headache, followed by nausea, dizziness = impending vestibular damage. (p 1020)
63. The nurse is caring for a patient receiving gentamicin (Garamycin) intravenously (IV). What statement by the patient would most concern the nurse?
Glucocoriticoids are used as prophylaxis for chronic asthma. (Example question during 10/18 lecture)
65. A nurse counsels a patient using two different types of asthma inhalers: a short-acting beta2 agonist and a corticosteroid. When the patient questions the purpose of the steroid inhaler, what would the nurse's best response be ?
Taken on a fixed schedule, not PRN. Suppresses inflammation -->decreases mucus. (p 890)
66. During education by the nurse what best demonstrates understanding of glucocorticoids?
IV diazepam for seizures, activated charcoal to decrease absorption, have lidocaine and crash cart available. (p 897)
67. A patient complains of vomiting, diarrhea, and insomnia. During the assessment, the patient begins having seizures. The nurse suspects theophylline toxicity. What actions would be the nurse's priority intervention?
Over time if TB develops resistance to one drug, the other drug will be able to kill the TB. Multi-drug regimen will also reduce incidence of relapse. (P 1038)
68. A patient is beginning therapy for active tuberculosis (TB). The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response?
Initially 4 drugs used, isoniazid & rifampin almost always included. (This 2 month induction phase tries to eliminate actively dividing tubercles so the sputum becomes noninfectious. P 1039)
69. The nurse describes a typical course of therapy to a patient newly diagnosed with active tuberculosis. What would this be?
At least 24 months. (P 1039)
70. A patient who has been diagnosed with multidrug-resistant tuberculosis asks how long the treatment regimen will last.
Sputum evaluated q 2-4 weeks, then monthly after sputum cultures become negative. (P 1040)
71. An adult has active tuberculosis, as diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse would want to see which finding?
Discontinue the isoniazid, monitor for hepatitis (anorexia, malaise, fatigue, nausea, jaundice. P 1044 & 1045.)
72. A patient being followed for latent tuberculosis has been on isoniazid therapy for 2 months. While reviewing the laboratory test results, the nurse notes that the liver function test results have become grossly abnormal. The nurse expects which course of action to be ordered?
(This is AZT.) Hemoglobin value must be above 5 (gm/dL), granulocyte count, neutrophil count must be above 750 (cells/mL), plasma HIV RNA level and CD4 T-cell count. (P 1092, 1126, 1127.)
73. The nurse is caring for a patient who is HIV positive and is taking zidovudine (Retrovir). Before administering the medication, the nurse should monitor which laboratory values?
D/C drug and draw arterial blood to Diagnose lactic acidosis.
(Rash, fever indicate hypersensitivity rxn to abacavir. Should be D/C'd, never used again.
Zidovudine (Retrovir)—AZT, one of many symptoms of lactic acidosis is fatigue.)
74. The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine (Trizivir). The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1° F. What is the nurse's best course of action?
AVOID lovastatin and simvastatin--can accumulate to dangerous levels. (P 1100)
75. The nurse is caring for a patient on a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with what drug?
Urinary Sx w/ (benign prostatic hypertrophy) BPH. (p 1269)
76. The nurse is obtaining a health history from a 70-year-old patient. The patient states that, in addition to other medications and herbals supplements, he takes saw palmetto daily. What health problems does the nurse suspect the patient is using it?
78. The nurse is administering morning medications. A patient questions the nurse, "How does the drug know where to go?" The nurse's best response to the patient is based on the understanding that a drug that elicits only those responses for which it is given is considered ___________.
pharmacokinetics (from midterm)
79. A nurse is teaching a continuing education class on pharmacology. The nurse is evaluating the participants' knowledge and poses the question, "When a disease process triggers increased metabolism of the drug, the disease has altered the drug's ___________."
80. A patient with a history of hepatomegaly secondary to cirrhosis is admitted to a medical-surgical unit. Among the patient's many medications, acetaminophen (Tylenol) is prescribed. The nurse understands that this drug should not be used in patients with impaired liver function. Which term describes the nurse's understanding of the relationship between acetaminophen and its use in patients with impaired liver function?
FDA approved for one use, but prescribed for another purpose. (From midterm)
81. A prescriber orders a drug that is considered "off label." A patient asks what "off label" means. The nurse correctly explains that "off label" is _____________.
number of drugs the patient is taking. (From midterm)
82. During a lecture the instructor discusses drug-to-drug interactions. The students recall that the risk of serious drug-to-drug interactions is directly proportional to the ________.
Assess for changes in respiratory pattern and wheezing. (from midterm)
83. An hour after taking a medication, a nurse notes that the patient displays urticaria and pruritus. What is the nurse's priority action?