Exam 4 Flashcards
What is the schedule for the Hepatitis A vaccine for children?
First dose between 12 and 23 months, second dose at least 6 months after the first
When should the Hepatitis B vaccine be administered?
Within 12-24 hours after birth, additional doses at 1-2 months and 6-18 months, third dose should not be given prior to 24 weeks of age
What are the two formulations available for the Rotavirus vaccine?
RV-5 (three-dose series at 2, 4, 6 months) and RV-1 (two-dose series at 2 and 4 months)
What is the maximum age for the final dose of the Rotavirus vaccine?
8 months, 0 days
What is the DTaP vaccine schedule for children? (5 doses)
Doses at 2, 4, 6, 15-18 months, and 4-6 years
What does the Haemophilus influenzae type b (Hib) vaccine prevent?
A serious type of meningitis commonly seen in children
How many doses are in the Hib vaccine series?
4-dose series at 2, 4, 6, and 12-15 months
At what ages is the Inactivated poliovirus (IPV) vaccine administered? (4 doses)
2, 4, and 6-18 months, and 4-6 years
What does the pneumococcal vaccine (PCV) prevent?
Meningitis, pneumonia, and middle ear infections caused by streptococcus pneumoniae
What is the MMR vaccine schedule? (2 doses)
Doses at 12-15 months and 4-6 years
What is the vaccination schedule for Varicella (chickenpox)? (2 doses)
One dose at 12-15 months and 4-6 years, or two doses at least 4 weeks apart if after age 13
At what age should the Tdap booster be given?
Between ages 11 and 12 after completing the DTaP series
What is the HPV vaccine recommended for?
Adolescents ages 11-12 (3 doses)
What is the schedule for MenACWY vaccine?
1st dose at 11-12 years, 2nd dose (booster) at 16 years
What is the frequency of the Tetanus & diphtheria (TD) vaccine for adults?
Every 10 years
What is the indication for Methotrexate?
Severe psoriasis, acute lymphoblastic leukemia, polyarticular juvenile idiopathic arthritis
What is the action of Methotrexate?
Folate antagonist; inhibits dihydrofolate reductase, blocking folic acid synthesis
What are common adverse effects of Methotrexate?
Hepatic fibrosis, severe bone marrow suppression, GI ulceration, pneumonitis
What is the definition of ‘Nadir’ in chemotherapy?
Time following chemotherapy when blood cell counts reach their lowest level
What causes nausea and vomiting during chemotherapy?
Stimulation of the chemoreceptor trigger zone (CTZ) in the brain
What is the prototype drug for nitrogen mustards?
Cyclophosphamide
What are the side effects of Doxorubicin?
Severe bone marrow suppression, N/V, red coloration to urine and sweat
What is the action of gonadotropin-releasing hormone agonists like Leuprolide?
Prevents the release of luteinizing and follicle-stimulating hormones to prevent testosterone production
What is the expected pharmacological action of Tamoxifen?
Blocks estrogen receptors to treat estrogen-receptor-positive metastatic breast cancer
What are the nursing actions for monitoring patients on Tamoxifen?
Monitor for abnormal bleeding, leg pain, chest pain, and cholesterol levels
What are isotonic solutions?
Fluids that resemble plasma, keeping cells in the vascular space, with osmolality of 250 to 375 mOsm/L
What are examples of isotonic solutions?
- 0.9% sodium chloride
- 5% dextrose in water
- Lactated Ringer’s (LR)
What is the osmolality of hypertonic solutions?
Equal to or greater than 375 mOsm/L
What is the drop factor for micro-drip IV tubing?
Delivers 60 drops/ml
What is the importance of monitoring I/O in patients receiving nitrogen mustard drugs?
To ensure adequate hydration and monitor for kidney toxicity
What are the two types of IV tubing sets?
Macro-drip and micro-drip sets
Macro-drip delivers 10, 15, or 20 gtts/ml; micro-drip delivers 60 gtts/ml.
When is micro-drip IV tubing primarily used?
In pediatric or neonatal care
It is used when small amounts of fluids are to be administered over a long period.
What should be verified before accessing a central venous access device (CVAD)?
CXR verifies the tip is positioned near the cavo-atrial junction (CAJ)
The CAJ is where the lower third of the SVC meets the upper RA.
List some risks associated with central line access.
- Blockage
- Pain
- Bleeding
- Infection
- Blood clots
- Migration or kinking
- Accidental removal
- Collapsed lung
What is the primary use of peripheral IV lines?
Short-term treatments
Peripheral IV lines can only be used for a few days.
What is the first-line drug for rheumatoid arthritis (RA)?
Methotrexate
It is considered a Disease Modifying Antirheumatic Drug (DMARD).
Name two types of glucocorticoids used for RA.
- Short-acting: hydrocortisone, cortisone
- Intermediate-acting: methylprednisolone, prednisolone, prednisone, triamcinolone
- Long-acting: betamethasone, dexamethasone
What are the two main classes of anti-inflammatory agents for gout?
- NSAIDs (first line treatment)
- Glucocorticoids (alternative treatment)
What is the action of allopurinol?
Inhibits uric acid formation
Testing for HLA-B*5801 is recommended for specific ancestries to prevent severe adverse reactions.
What is the primary treatment goal for osteoporosis?
Maintain or increase bone strength
What is the significance of a T-score of -2.5?
Indicates osteoporosis
It represents 20% bone loss compared to the mean.
List some adverse effects of alendronate.
- Esophagitis
- Atypical femoral fractures
- Esophageal cancer
- Musculoskeletal pain
- Ocular problems
- Osteonecrosis of the jaw
What are the primary cholinesterase inhibitors used for dementia?
- Donepezil
- Galantamine
- Rivastigmine
What is the mechanism of action of memantine?
Blocks calcium influx at NMDA receptors
It modulates the effects of glutamate, critical for memory and learning.
What is the first-line drug for Parkinson’s disease?
Levodopa/carbidopa
What are the main types of pain classified in pain management?
- Somatic
- Visceral
- Neuropathic
What is the mechanism of action for gabapentin?
Binds to voltage-gated calcium channels in the CNS
This stabilizes neuronal membranes and affects the transport of neurotransmitters.
What are the two classes of local anesthetics?
- Ester-type
- Amide-type
What is the primary use of lidocaine?
Most widely used local anesthetic
It can be used for both topical and injectable applications.
What is a common adverse effect of local anesthetics?
- CNS excitation followed by depression
- Cardiovascular suppression
- Allergic reactions
What should be avoided when applying topical anesthetics?
- Large areas of skin
- Broken skin
- Strenuous activity
What is the action of dopamine replacement therapy in Parkinson’s?
Increases dopamine synthesis in the striatum
What are vasoconstrictive medications primarily used for?
Reuptake of norepinephrine by adrenergic neurons
Think CNS.
What are the therapeutic uses of topical vasoconstrictive medications?
Relief from pain, itching, and soreness in:
* Skin (sunburn, insect wounds)
* Mucous membranes (ENT, trachea, anal fissures, hemorrhoids)
If absorbed systemically, it can be toxic.
What precautions should be taken when using topical vasoconstrictive medications?
Use small amounts, avoid large areas, broken skin, strenuous activity, and do not wrap or heat the site.
What is a significant risk when injecting vasoconstrictive medications?
Injury to arteries or veins; aspirate prior to injections to check for blood return.
What is the Black Box Warning associated with ibuprofen?
GI Bleed
Less GI bleeding compared to aspirin but still a risk.
List contraindications for ibuprofen use.
- Hypersensitivity (including aspirin)
- Active GI bleed/ulcer
- CABG surgery
- History of MI
- Severe heart failure
- Avoid after 30 weeks of pregnancy.
What are common adverse effects of ibuprofen?
- Constipation
- Dyspepsia
- Nausea
- Vomiting
- Headache
- Renal failure
- SJS
- Intraventricular hemorrhage.
What should patients be educated about when taking ibuprofen?
- Do not take concurrently with aspirin
- Take with food or water/milk
- Avoid alcohol
- Maximum doses: Adults 3200 mg/day; Children 2.4 g/day.
What is the definition of a controlled substance according to the DEA?
Drugs, substances, and certain chemicals classified into five categories based on acceptable medical use and abuse potential.
What are Schedule I drugs characterized by?
No currently accepted medical use and a high potential for abuse.
Examples include heroin, LSD, marijuana.
What are examples of Schedule II drugs?
- Hydrocodone (e.g., Vicodin)
- Cocaine
- Methamphetamine
- Oxycodone (e.g., OxyContin)
- Fentanyl.
What defines Schedule III drugs?
Moderate to low potential for physical and psychological dependence.
What are common examples of Schedule IV drugs?
- Xanax
- Valium
- Ambien
- Tramadol.
What is the indication for Schedule V drugs?
Lower potential for abuse, used for antidiarrheal, antitussive, and analgesic purposes.
What are the common adverse reactions to opioids?
- Hypotension
- Constipation
- Confusion
- Sedation
- Respiratory depression.
What nursing considerations should be taken for opioid administration?
- Start low for opioid naïve patients
- Assess pain before and after administration
- Monitor LOC, BP, HR, RR, and pulse oximetry.
What are the indications for COX 1 inhibitors?
- Analgesia
- Reduction of inflammation
- Fever reduction
- Decreased incidence of TIA & MI.
What are the adverse effects of COX 1 inhibitors?
- GI bleeding
- Dyspepsia
- Hepatotoxicity
- Hypersensitivity.
What is the main function of COX 2?
Mediates inflammation and sensitizes receptors to painful stimuli.
What distinguishes first-generation NSAIDs from second-generation NSAIDs?
First-generation NSAIDs inhibit both COX 1 & 2, while second-generation NSAIDs selectively inhibit COX 2.
What are the indications for acetaminophen?
- Mild pain
- Fever
- Moderate/severe pain (IV only).
What are the contraindications for acetaminophen?
- Hypersensitivity to certain substances
- Severe hepatic impairment.
What is the primary use of acetaminophen?
Pain relief and fever reduction
Acetaminophen is commonly used to relieve mild to moderate pain and reduce fever.
What are the contraindications for acetaminophen?
- Hypersensitivity to alcohol
- Severe hepatic impairment
- Acute liver disease
- Drug-drug interactions with other hepatotoxic substances
These contraindications are important to consider to avoid serious health risks.
What are common adverse effects of acetaminophen?
- SJS (Stevens-Johnson syndrome)
- Constipation
- Hepatotoxicity
- Renal failure
- Agitation in children
Awareness of these adverse effects is critical for patient safety.
What nursing considerations should be taken when administering acetaminophen?
- Assess liver and kidney function
- Monitor alcohol use
- Do not exceed maximum daily dose
- Limit duration of use (10 days for adults, 5 days for children)
- Avoid alcohol consumption
These considerations help prevent overdose and liver damage.
What is the antidote for acetaminophen overdose?
N-Acetylcysteine (Acetadote)
This antidote is crucial in treating acetaminophen overdose effectively.
Which type of immunity does the MMR vaccine provide?
Artificial active immunity
This type of immunity is developed through vaccination.
What is a contraindication for taking tamoxifen?
Deep-vein thrombosis
Patients with a history of deep-vein thrombosis should not take tamoxifen due to increased risk.
What adverse effects should a client on maraviroc report?
- Paresthesia
- Cough
- Jaundice
- Fever
Reporting these symptoms can help detect serious complications early.
What instructions should a nurse give for self-administering enfuvirtide?
“Allow the vial to sit until the solution is completely clear and without particulates.”
Proper preparation of the medication is essential for effective treatment.
Which over-the-counter drug should be avoided by a client on topotecan therapy?
Ibuprofen
Ibuprofen can increase the risk of renal toxicity when taken with topotecan.
What instructions should be included for a client taking mercaptopurine?
- Use contraception if pregnancy is a risk
- Perform oral hygiene frequently
- Perform hand hygiene frequently
- Avoid activities that can cause injury
These precautions help minimize the risk of infection and complications.
What condition is maraviroc used to treat?
Chemokine receptor 5 (CCR5)-tropic HIV-1
Maraviroc specifically targets this type of HIV.
What should a nurse monitor for in a client receiving vincristine?
Weak hand grasps
This could indicate neurological adverse effects of the drug.
What drug should be administered alongside intrathecal cytarabine to reduce neurotoxicity?
Dexamethasone
Dexamethasone is used to mitigate potential side effects of cytarabine.
What is the purpose of combining zidovudine with ritonavir in HIV treatment?
To prevent drug resistance
This combination is effective in managing HIV-1.
What immunization should a client receive starting at 50 years of age?
Herpes zoster vaccine
This vaccine is recommended to prevent shingles in older adults.
What laboratory value should be reported for a client on zidovudine?
Hemoglobin 7.1 g/dL
This low hemoglobin level indicates possible anemia, a common side effect of zidovudine.
What actions should a nurse take when administering paclitaxel IV?
- Give the client an antihistamine
- Administer the drug through non-PVC tubing
- Use an in-line filter
These steps help prevent allergic reactions and ensure proper drug delivery.
What immunization should a nurse include for a 4-month-old infant?
Haemophilus influenzae type B vaccine (Hib)
This vaccine is part of the recommended immunization schedule for infants.
What adverse reactions should a client on delavirdine/efavirenz therapy report?
Rash
A rash may indicate a serious drug reaction that requires immediate attention.
What age range should be included for the human papillomavirus (HPV) vaccine?
11 to 12 years old
Vaccination in this age range is recommended for optimal protection against HPV.
