Exam 3: 37 Questions Flashcards by N/A N/A

What are glycoprotein inhibitors (Aggrastat) used for?

unstable angina/MI

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When do you discontinue antiplatelets prior to surgery?

1 week; 7 days

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What is a side effect of Aspirin?

tinnitus
Hemorrage Bleed (brain bleed)

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What do antiplatelet’s interact with?

Concurrent use of NSAIDs, anticoagulants, thrombolytics, and other antiplatelets

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What are the Anticoagulants drugs?

Heparin (IV & SC)
LMWH - enoxaparin (Lovenox)
warfarin (Coumadin)

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When situations would a nurse give Heparin in?

Emergent situations (stroke, pulmonary embolism, massive DVT)

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What medication prevents clots during specific surgeries and post-op venous thrombosis?

Heparin

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Which route of heparin doses should be double checked with another nurse?

IV doses

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Does Lovenox often cause bruising?

YES

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When is enoxaparin (Lovenox) given?

When patients are at high risk for blood clots (immobile, elderly, post-op)

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What are the administration techniques for Lovenox?

2 inches away from the umbilicus
Do not: do a Z-track, remove bubble, or rub the site where medication was administrated

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Can Lovenox be used as an anticoagulation “bridge” before surgery?

YES

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When should you stop heparin?

When platelets are less than 100,000/mm3

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How do you check for allergies to heparin?

By giving a small initial “test” dose

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What is the antidote for Heparin overdose?

Protamine sulfate (1 mg per 1 mg of heparin)

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What is the antidote for warfarin?

Vitamin K (2.5 mg PO, 0.5 - 1 mg IV)

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What does warfarin treat?

venous thrombosis, a-fib, prosthetic heart valves

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What does warfarin prevent?

MI, TIA, PE, and DVT

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How long does the full therapeutic effect take for Warfarin?

several days

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What labs should you monitor for Warfarin?

PT/INR (regularly)
Normal INR = 1-1.5
INR for MI, Afib, PE, and venous thrombosis = 2-3
INR for mechanical heart valves & reoccurring systemic embolism = 2.5 - 3.5

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What are some adverse effects of Warfarin?

bleeding, hemorrhage, hepatitis, lethargy, muscle pain, skin necrosis (“purple toes” syndrome)

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What factor is hemophilia A missing?

Factor VIII (clotting protein)

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What factor is hemophilia B (Christmas disease) missing?

Factor IX (clotting factor)

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Which type of hemophilia is more common?

Hemophilia A

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Medications for Hemophilia A

Plasma (Hemofil-M) Recombinant Factor VIII (Advate)

Medications for Hemophilia B

Plasma (AlphaNine SD) Recombinant Factor IX (Benefix)

What does hemophilia cause?

Excessive bleeding, easy bruising; bleeding in joints

What labs should a nurse monitor for hemophilia?

Hematocrit, direct Coombs test, Plasma factor VIII levels, and platelet count

What else should the nurse monitor for a patient that has hemophilia?

I&O; color of urine; swelling of joints; bleeding from gums, stool, or emesis; and vital signs

What temperature should you apply to a patient that has hemophilia?

Cold (Ice); heat will prolong the bleeding

How long should you apply pressure to IM or IV sites for a patient that has hemophilia?

Up to 5 minutes

Iron deficiency medications

ferrous sulfate (Feosol) PO Iron Dextran (INFeD) IM/IV

What labs do you run for a patient with iron deficiency anemia? and what are the normal ranges?

Hemoglobin: 13-18 g/100 mL Hematocrit: 45-52%

What should you take iron supplements with?

Vitamin C; orange juice

What can you not take iron supplements with?

Antacids or calcium (milk)

What can the IM injection of Iron Dextran cause?

Permanent black staining of the skin

What are some symptoms of iron poisoning/toxicity?

GI symptoms, dark bloody stools, vomiting blood & acidosis

What are some symptoms of shock resulting from iron poisoning/toxicity?

Hypotension, tachypnea, pallor then cyanosis, and coma

What are the two treatments of iron poisoning/toxicity?

Bowel irrigation and Desferal

What are the medications for pernicious anemia?

Vitamin B12 (Cobalamin) Cyanocobalamin (Nascobal) Cyanocobalamin (Cyanoject)

What is a common sign of B12 deficiency?

Numbness and tingling of the hands and feet (neuropathy)

What are some cardinal signs of pernicious anemia?

Beefy red tongue, pallor, and neuropathy

What are the normal levels for B12?

200-900

What labs should you watch for in a patient with pernicious anemia?

B12, Hemoglobin, Hematocrit, RBC, and reticulocyte counts

What are the medications for megaloblastic anemia?

Folic acid (Floacin), Vitamin B9, Vitamin B12, and Cyanocobalamin

What can folic acid be used for?

DNA erythropoiesis, megaloblastic anemias, and prevention of neural tube defects in fetus

What are signs of folic acid deficiency?

Pallor, fatigue, palpitations, and paresthesia

What is the normal folate range?

6-15 mcg/mL

When should a woman start taking folic acid?

1 month before planned pregnancy

When should anticipatory nausea/vomiting be treated?

1 hour before meals or treatment

What are antiemetics generally contraindicated with?

CNS depression & coma

When should antiemetics be used cautiously? (7 answers)

In patients with glaucoma, seizures, intestinal obstruction, prostatic hyperplasia, asthma, and cardiac, pulmonary, or hepatic disease

What labs should you monitor with use of antiemetics?

BUN & Creatinine (kidney function)

What is the antihistamine antiemetic?

meclizine hydrochloride (Antivert)

Which medication is used for motion sickness, treats vertigo and is over the counter?

Antivert

How early should you take Antivert before traveling?

1 hour

How often should you change a scopolamine patch?

Every 3 days

When should you apply a scopolamine patch?

4 hours before travel

Where do you apply a scopolamine patch?

Behind the ear

Which dopamine antagonist is a high risk in pediatric patients & older adults and causes drowsiness.

Promethazine

Which antiemetic makes the heart rate regular and prolongs QT intervals?

Zofran

What is an adverse effect of Reglan?

Tardive dyskinesia

When should you take Reglan?

30 minutes before a meal

Which glucocorticoid is not FDA approved, is short term, and has a rapid IV onset?

Dexmethasone

What is the last resort treatment for severe nausea/vomiting with chemo and also causes weight gain?

Dronabinol

What is an adverse effect of Aprepitant?

Deep vein thrombosis

How early should a patient take Aprepitant before a procedure?

3 hours before

Which medication is contraindicated with sesame oil?

Dronabinol

Which medications cause photosensitivity?

Dopamine antagonists (Compazine & Promethazine)

Which medication is contraindicated with narrow angle glaucoma?

Scopolamine

When do laxatives generally produce a laxative effect?

12-14 hours

When will a laxative take full effect?

Up to 2-3 days

When administering a laxative, is it essential to provide adequate fluid intake?

Yes

Why is it essential for a nurse to provide adequate fluid intake with laxatives?

It can cause an obstruction

What are some side effects of laxatives? (6 answers)

Abdominal discomfort, bloating, flatulence, n/v, diarrhea

What are some adverse effects of laxatives? (4 answers)

Allergic reactions, esophageal obstruction, swelling, or blockage

When should you give laxatives?

2 hours after meals and any oral medications

How long should laxatives be taken?

Short term

Which laxatives are frequently used to prevent straining with defecation in patients after a MI?

psyllium (Metamucil)

Which medication prevents patients from straining during a bowel movement?

docusate sodium (Colace)

Which medication would you not give with mineral oil or patients with congestive heart failure?

docusate sodium (Colace)

Should you give a patient a stool softener if they are on bed rest or using opioids?

Yes

Which medication should you not give with stool softeners?

Mineral oil

What can mineral oil impair?

Birth control pills, anticoagulants, cardiac glycosides, & sulfonamides

What is the biggest adverse effect with mineral oil?

Aspiration of product (can cause pneumonia)

What will increase a bleeding episode in a patient taking mineral oil?

Also taking a blood thinner

Which medication results in bowel distension, increased peristalsis, & evacuation?

Lactulose

What are adverse effects of Lactulose? (5 answers)

Magnesium toxicity, cramping, electrolyte imbalances, diarrhea, and increased thirst

Which laxative is very potent and induces complete & total cleansing of the bowel?

polyethylene glycol (Miralax)

Which laxative results in diarrhea after 30-60 minutes of administration?

polyethylene glycol (Miralax)

What are the adverse effects of bisacodyl (Dulcolax)? (6 answers)

Nutrient malabsorption, skin rashes, gastric irritation, electrolyte imbalances, discolored urine, & rectal irritation