Exam # 3 Study Guide Flashcards by Lucy Gomez

What are the Antihistamines that don’t cause drowsiness?

Fexofenadine

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What is the patient education after using an inhaler?

Because of drug inhalation, mouth dryness and throat irritation could result

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What is the Nursing responsibilities when administering Digoxin (Lanoxin)?

It has a narrow therapeutic index which means it requires close monitoring to ensure patient safety.

Avoid taking Danshen and Chan Su because it is know to interfere with tests to determine digoxin levels

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What are the common side effects of Flonase (Fluticasone)?

Nasal irritation, epistaxis

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What is the indication for use for (a leukotriene antagonist)?

Reduces inflammatory component of asthma (asthma prophylaxis)

Prevents airway edema and inflammation by blocking leukotriene receptors in airways

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What is the patient education for a leukotriene antagonist?

Watch for headaches, nausea, and diarrhea

-Advise patients not to use leukotriene modifiers during acute asthma attack

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A patient is receiving an expectorant. What symptom indicates to the nurse that the drug is exerting its therapeutic effect?

A. Bronchodilation.
B. Decreased coughing.
C. Loosening of bronchial secretions.
D. Relief of nasal congestion.

C. loosening of bronchial secretions.

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The nurse is teaching an older adult patient about guaifenesin. Which information is appropriate to include in this teaching? (Select all that apply.)

A. Take the drug with a glass of water.
B. Read labels on over-the-counter drugs and check with health care provider before taking cold remedies.
C. Take the drug at bedtime.
D. Advise patient to contact health care provider if cough persists more than 2 days.

ANS: A,B

A. Take the drug with a glass of water.
B. Read labels on over-the-counter drugs and check with health care provider before taking cold remedies.

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A patient has been diagnosed with the common cold. Which drug should the nurse question if it is ordered to treat this patient?

A. Antihistamines
B. Antitussives
C. Expectorants
D. Antibiotics

D. Antibiotics

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Which medication is a first-generation antihistamine?

A. Cetirizine
B. Fexofenadine
C. Diphenhydramine
D. Loratadine

C. Diphenhydramine

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When teaching a patient about use of nasal decongestant sprays, the nurse informs the patient that they are most effective and less likely to lead to rebound congestion when administered for how many days?

A. 3 days
B. 10 days
C. 14 days
D. 20 days

A. 3 days

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Which of the following history is most important for the nurse to assess before administering diphenhydramine?

A. Allergy to penicillin.
B. Hypertension.
C. Diabetes mellitus type 2.
D. Closed-angle glaucoma.

D. Closed-angle glaucoma.

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Which statement about benzonatate does the nurse identify as being true?

A. It is an opioid antitussive.
B. It suppresses the cough center of the medulla.
C. It suppresses respirations.
D. It causes physical dependence.

B. It suppresses the cough center of the medulla.

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A patient has just received a nebulizer treatment of metaproterenol. It is most important for the nurse to assess the patient for the development of which side effect/adverse effect?

A. Tremors
B. Bradycardia
C. Hyperkalemia
D. Constipation

A. Tremors

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Which of the following is best to teach a patient with chronic obstructive pulmonary disease about the use of the medication, albuterol?

A. Mobilizes respiratory secretions
B. Decreases the cough response
C. Increases the work of breathing
D. Dilates the bronchioles long-term

D. Dilates the bronchioles long-term

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Which of the following should the nurse teach regarding the use of cromolyn in the treatment of asthma?

A. Assist in opening narrowed airways
B. Suppress the release of histamine and other mediators from the mast cells
C. Loosen mucus from the airways
D. Prevent serious complications from bacterial infections

B. Suppress the release of histamine and other mediators from the mast cells

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A patient is using a glucocorticoid inhaler. The patient asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. Which of the following is the best response from the nurse?

A. Avoid mucous membrane breakdown
B. Increase hydration of the oral mucosa
C. Decrease risk of infection
D. Slow the development of cavities

C. Decrease risk of infection

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A home care nurse is visiting a patient with asthma who suddenly experiences an acute asthma attack. Which drug should the nurse prepare to administer?

A. Zafirlukast
B. Cromolyn
C. Metaproterenol
D. Zileuton

C. Metaproterenol

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A patient with chronic bronchitis is admitted to the health care facility for treatment of a bacterial respiratory infection. Which antimicrobial will most likely be ordered for the patient?

A. Seldane
B. Amphotericin B
C. Acyclovir
D. Trimethoprim-sulfamethoxazole

D. Trimethoprim-sulfamethoxazole

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What is the indication of use for Lidocaine infusion?

Lidocaine is a common local anaesthetic that can be delivered by intravenous (IV) infusion to relieve chronic pain. It has also proven to be useful in the treatment of certain types of headaches.

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Changing Injectable anticoagulant to oral anticoagulant?

-May need to monitor the value more frequently the electrolytes??
-Continue injecting the other medication
-Monitor for toxicity
-Monitor for nose bleeding, bruising, abnormal bleeding

-Teach PT to monitor toxicity, what they call PCP if they see blood in urine or feces

-DONT combine antiplatelet medication

-Encourage to not smoke & DONT mix protein binding medication (Take separately)

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What are the adverse effects for Lipitor (Atorvastatin)?

H/A, Fatigue, Muscle or Joint pains, Heartburn, Severe myopathy/Rhabdomyolysis–RARE but possible

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What is the adverse effects of antihypertensive in geriatric patients?

Orthostatic hypotension!!

-Instruct the older adult to modify their lifestyle and activities

-Restrict dietary sodium to 2400 mg daily, avoiding tobacco, modifying diet, exercising, and decreasing stress

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What is the best anti hypertensives for African American patients?

-Hydrochlorothiazide

-Most effective is alpha 1 blockers and calcium channel blocker (calcium blockers)

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What adverse effects of antihypertensive drugs in male patients?

Both systolic and diastolic hypertension are associated with increased cardiovascular morbidity and mortality

What are the side effects of Ace Inhibitors?

Primary Side Effect: constant, irritated cough. Other side effects: Nausea, vomiting, diarrhea, headache, dizziness, fatigue, insomnia, serum potassium excess (hyperkalemia), and tachycardia - Ends with -pril -It inhibits the formation of angiotensin II (vasoconstrictor) and blocks the release of aldosterone -African Americans and Older Adults DO NOT respond to ACE inhibitors

What is the best treatment for increased intracranial pressure & cerebral edema?

Medical management of increased ICP should include sedation, drainage of CSF, and osmotherapy with either mannitol or hypertonic saline. -It is an osmotic diuretic

What is the nursing education and management of a patient on Beta Blocker?

-Monitor vital signs, especially BP and pulse -Monitor lab results, especially BUN, serum creatinine, AST, and LDH -Encourage PTs to comply with drug regimen - Inform PTs that herbs can interfere with beta blockers -Advise PTs to avoid over-the-counter (OTC) drugs without first checking with a health care provider

The patient on thiazide diuretic, what electrolyte should be monitored?

They should monitor their potassium levels (hypokalemia)

What are the undesirable effects of thrombolytic therapy?

Internal bleeding, bleeding, history of stroke or head injury within the past 3 months, recent trauma within 14 days, uncontrolled hypertension, arterio-venous malformation

What are the undesirable effects of nasal decongestants?

Rebound congestion when used intranasal for longer than 5 days - Minor stinging and dryness in nasal mucosa may be experienced

What is the patient teaching for anticholinergic therapy?

-Patients should discard any capsules that are opened and not use immediately -HandiHaler device should be washed with warm water and dried -Instruct patient that frequent rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth -May cause drowsiness.

What is the indication for use of nitrates and nursing management

-Never stop it directly -Wear gloves with nitrate because it can affect you -Never put a patch in the same place -PT should raise slowly -Have a urinal close by & a night light

What is the indication for use of low molecular weight heparin (LMWH)?

-Mechanism of action is similar to heparin except inhibition is more specific to Factor X -They are administered parenterally - Duration of action is 2-4X longer than heparin -Less likely than heparin to cause thrombocytopenia -Enoxaparin (Lovenox) Dalteparin (Fragmin) -Instruct PTs not to take ASA, while taking LMWH's

What is the best anti dysrhythmia for severe ventricular dysrhythmias?

Amiodarone (first) and Lidocaine??

What is the patient taking atorvastatin for hyperlipidemia what lab values must be monitored?

Creatinine kinase levels and their liver function must be monitored -Blood tests

What are the medications for high triglyceride levels

- Fibrates Acid = Gemfibrozil (Lopid), Fenofibrate (Tricor, Anatara), Fibricor - Nicotinic acid (Niaspan) - High doses of omega-3s are needed to lower triglycerides and should be taken only under a doctor's care. Epanova, Lovaza, and Vascepa are prescription forms of omega-3s.

What are some Diuretics' that increase K+?

1) Spironolactone 2) Aldosterone 3) Amiloride 4) Triamterene 5) Eplerenone

What is the Antitode for Warfarin toxicity?

Vitamin K

What is the goal of anticoagulants?

- It inhibit specific clotting factors to prevent formation or enlargement of clots - To prevent formation of clots in veins, to treat thromboembolic disorders

What is the Warfarin interaction with garlic?

- It decreases the effectiveness of Warfarin - May lead to an increased anticoagulation effect of Warfarin (Causes more bleeding) -

What antilipemic drug that cause myopathy?

Atorvastatin and Simvastatin ???

What to monitor patient for antilipemic drugs?

- Assess vital signs and baseline serum chemistry values - Obtain medical history; Statin drugs are contraindicated for patients with liver disorders and in pregnant patients - May take several weeks before blood lipid levels decline

What food-drug interacts with antilipemics?

- Explain to PTs that GI discomfort is a common problem with most antihyperlipidemic. Suggest increasing fluid intake when taking the mediation - Encourage PTs to consume foods that are low in animal fats, cholesterol, and complex sugars. Lovastatin and other antihyperlipidemic are adjuncts to, not substitutes for, a low-fat diet

What is the patient education on antihypertensive therapy?

- Patients should be compliant with medication therapy and take the medication at the same time each day. - Do not abruptly cease medication as arrhythmias, hypertension, or ischemia may develop. - Patients and families should be instructed to check pulse and blood pressure and report abnormalities to the healthcare provider. Additionally, these medications may cause side effects of dizziness and cold sensitivity

What antiarrhythmic drugs cause constipation?

1) Disopyramide phosphate 2) Flecainide 3) Propfenone hydrochloride 4) Amiodarone 5) Verapamil hydrochloride

Cause of Amiodarone related deaths?

- Can cause nausea, vomiting, hypotension, and neurologic problems -Potentially prodysrhythmic because of the pharmacologic activity of the drug on the heart and the inherently unpredictable activity of a diseased heart, with or without the use of drugs - In some cases, life-threatening ventricular dysrhythmias can result from appropriate and skillful attempts at drug therapy to treat patients with heart disease

Chest pain treatment with Nitroglycerine?

- Sublingual (SL) nitroglycerin is the most commonly used nitrate. - It is also available as topical (transdermal patch, ointment), translingual, oral extended-release capsule and tablet, and aerosol spray (inhalation), and IV. -Mostly used to treat angina - After a dose of nitroglycerin, the PT may experience dizziness, faintness, or headache as a result of the peripheral vasodilation

What is the patient education for Furosemide?

- Instruct patient to take furosemide as directed. - Take missed doses as soon as possible; do not double doses. - Caution patient to change positions slowly to minimize orthostatic hypotension. -Licorice may increase potassium loss

Why a patient with liver disease may receive Captopen?

What is Good Cholesterol? (HDL)

>60 mg/dL

What is Bad Cholesterol? (LDL)

<100 mg/dL

A patient with chronic bronchitis is admitted to the health care facility for treatment of a bacterial respiratory infection. Which antimicrobial will most likely be ordered for the patient? A. Seldane B. Amphotericin B C. Acyclovir D. Trimethoprim-sulfamethoxazole

D. Trimethoprim-sulfamethoxazole

A patient’s serum lipids are cholesterol 197 mg/dL, low-density lipoprotein (LDL) 110 mg/dL, and high-density lipoprotein (HDL) 35 mg/dL. What should the nurse conclude about these values? A. Serum lipids are within desirable values. B. Cholesterol is within desirable value, but LDL and HDL are not. C. Cholesterol is not within desirable value, though LDL and HDL are. D. Cholesterol, LDL, and HDL are not within desirable values.

B. Cholesterol is within desirable value, but LDL and HDL are not.

A nurse who is administering atorvastatin realizes the importance of monitoring for which serious adverse reaction? A. Pharyngitis B. Rash/pruritus C. Rhabdomyolysis D. Agranulocytosis

C. Rhabdomyolysis

A patient is scheduled to receive gemfibrozil. It is most important for the nurse to assess for concurrent use of which medication? A. Acetaminophen B. Ibuprofen C. Warfarin D. Folic acid

C. Warfarin

A patient is receiving medication therapy for peripheral vascular disease. Which medication does the nurse identify as an antiplatelet drug? A. Cilostazol B. Papaverine C. Prazosin D. Nifedipine

A. Cilostazol

Which herb is most often associated with the treatment of intermittent claudication? A. Ginseng B. Valerian C. St. John’s wort D. Ginkgo biloba

D. Ginkgo biloba

A patient is taking furosemide 40 mg daily for heart failure and hypertension. What is most important for the nurse to assess the patient for the development of? A. Low serum potassium, sodium, and magnesium, and elevated calcium B. Low serum potassium and sodium, and elevated magnesium and calcium C. Low serum potassium, sodium, magnesium, and calcium D. Low serum potassium and sodium, with magnesium and calcium remaining normal

C. Low serum potassium, sodium, magnesium, and calcium

Which statement will the nurse include when teaching a patient about loop diuretics? A. Take the medication at bedtime. B. Take the medication on an empty stomach. C. Rise slowly from a lying or sitting to standing position to prevent dizziness. D. Avoid fruit and vegetables in the diet.

C. Rise slowly from a lying or sitting to standing position to prevent dizziness.

A patient is admitted to the intensive care unit with increased intracranial pressure. Which of the following does the nurse would anticipate administering? A. Furosemide B. Mannitol C. Triamterene D. Spironolactone

B. Mannitol

A patient is receiving furosemide. What is most important for the nurse to monitor the patient for the development of? A. Hyperkalemia B. Hypokalemia C. Hyponatremia D. Hypernatremia

B. Hypokalemia

A patient with congestive heart failure gains 5 pounds in 1 week. Which of the following most indicates a fluid weight gain of 5 pounds? A. ½ L. B. 1 L. C. 2 L. D. 3 L.

C. 2 L.

Which statement about aldosterone does the nurse identify as being true? A. Aldosterone promotes sodium excretion. B. Aldosterone is a mineralocorticoid hormone. C. Aldosterone promotes potassium retention. D. Aldosterone is secreted by the pancreas.

B. Is a mineralocorticoid hormone

A patient with chronic glaucoma is most likely to receive which drug? A. A thiazide diuretic B. A loop diuretic C. A potassium-sparing diuretic D. A carbonic anhydrase inhibitor

D. A carbonic anhydrase inhibitor

A patient’s blood pressure (BP) is 128/82 mm Hg. Which of the following stages does the nurse place this BP? A. within the normal BP range. B. within the elevated BP range. C. indicating stage 1 hypertension. D. indicating stage 2 hypertension.

A. Within the elevated BP range

A patient is receiving an angiotensin II receptor blocker. Which does the nurse recognize as an angiotensin II receptor blocker? A. Valsartan B. Amlodipine C. Captopril D. Metoprolol

A. Valsartan

A patient is receiving an angiotensin II receptor blocker. Which of the following is most important for the nurse to assess the patient? A. Constipation B. Tremors C. Asthmatic attacks D. Dizziness

D. Dizziness

An African-American patient is to be treated with initial monotherapy to control hypertension. Which of the following does the nurse expects the patient to receive? A. Diuretics B. Angiotensin-converting enzyme inhibitors C. Alpha-adrenergic blockers D. Beta blockers

C. Alpha-adrenergic blockers

The nurse should instruct a patient to tapper off medication gradually and not suddenly stop taking antihypertensives in order to avoid which of the following? A. Rebound bradycardia B. Rebound tachycardia C. Rebound hypertension D. Rebound hypotension

C. Rebound hypertension

A patient with hypertension is ordered to receive an angiotensin-converting enzyme inhibitor. Which of the following does the nurse identify as a common benign side effect of this drug category? A. Hiccups B. Flatulence C. Abdominal distention D. Dry cough

D. Dry cough

Before administering the alpha-adrenergic blocker prazosin, which of the following is most important for the nurse to assess the patient for a history of? A. Renal disease B. Refractory heart failure C. Hypertension D. Benign prostatic hypertrophy.

A. Renal disease

A patient is prescribed aspirin, 81 mg, and clopidogrel. Which of the following drug classifications does the nurse identify for clopidogrel? A. Anticoagulant B. Thrombotic inhibitor C. Antiplatelet D. Thrombolytic

C. Antiplatelet

A patient arrived in the emergency department 2 hours after an acute ischemic stroke. The patient is given an intravenous (IV) injection of alteplase tPA. What is most important for the nurse to monitor? (Select all that apply.) A. Bleeding B. Vital signs C. PT levels D. Allergic reactions E. Electrocardiogram

ANS: A,B,D,E A. Bleeding B. Vital signs D. Allergic reactions E. Electrocardiogram

Which information will the nurse include when teaching a patient about warfarin therapy? A. Increase the amount of green, leafy vegetables in your diet. B. Rinse your mouth instead of brushing your teeth. C. Follow up with laboratory tests such as PT or INR to regulate warfarin dose. D. Use a new razor blade each time you shave.

C. Follow up with laboratory tests such as PT or INR to regulate warfarin dose.

A patient is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote in case it is needed? A. Vitamin K B. Protamine sulfate C. Warfarin D. Aminocaproic acid

B. Protamine sulfate

The nurse is caring for a patient who received alteplase tPA for treatment of acute coronary syndrome. The patient starts to bleed. The nurse anticipates administration of which medication? A. Protamine sulfate B. Vitamin K C. Warfarin D. Aminocaproic acid

D. Aminocaproic acid

A patient is receiving the alkylating drug cyclophosphamide (Cytoxan). It is most important for the nurse to provide A. IV hydration and assessment of fluid status. B. vigilant skin care and cleaning with mild soap. C. mouth care using half-strength H2O2 and a soft toothbrush. D. patient-controlled analgesia with meperidine (Demerol).

A. IV hydration and assessment of fluid status.