Kaplan Content Review - Chapter 1 Flashcards
1
Q
Blood should be infused within ____ hrs for each unit. How frequently during this time should vital signs be obtained?
What should you change for each unit of blood?
A
2hrs
Every our until complete and then hourly for 3 hrs
Entire IV line
2
Q
What should you do if a blood transfusion reaction is suspected? (6)
A
Stop blood
Restart NS
Save blood container and tubing and return to blood bank
Draw blood sample for plasma, hgb, culture, retyping
Collect urine sample + send to lab for hgb determination
Monitor urine symptoms for hematuria
3
Q
What is an allergic reaction/hypersensitivity to blood transfusion?
When does it occur?
A
Hypersensitivity to antibodies in donor’s blood
Immediate or w/n 24hrs
4
Q
What is an acute intravascular hemolytic blood transfusion reaction?
When does it occur?
What are the s/s?
A
Incompatability with donated blood
Within mins to 24 hrs
N/V
Fever
Low back pain
Tachy
Decreased UOP
Hematuria
5
Q
What would a blood transfusion circulatory overload look like?
A
Dyspnea
Crackles
Tachypnea
Tachy
6
Q
Isotonic fluids have the same concentration as _____
Hypertonic solution have a concentration greater than the _____
A
ECF
ECF
7
Q
Isotonic fluids: 3 types
Main function:
A
NS
LR
D5W
Maintain / restore F + E balance
8
Q
Hypotonic solution
Hypertonic solution
A
0.45% NS
3% NS
Sodium Bicarb 5%
10-15% dextrose in water
9
Q
You are giving IV fluids to a pt and they have suspected circulatory overload. What would you observe? What are the 4 nursing care steps to address this?
A
Crackles
Dyspnea
Confusion
Seizures
- Reduce IV rate
- Asses VS
- Asses lab values
- Notify HCP
10
Q
You suspect infiltration / extravasation. What s/s would you see? Nursing care steps? (4)
A
Edema
Pain
Coolness in area
Decrease in flow rate
- D/c IV
- Apply warm compress to site
- Sterile dressing
- Elevate arm
11
Q
What are s/s of phlebitis? What should you do? (3)
A
Redded, warm area at IV site
Tenderness
Swelling
- D/c IV
- Apply warm, moist compress
- Restart IV at new site
12
Q
What would you see with an IV line hematoma? What would you do as the nurse? (3)
A
Eccymosis
Immediate swelling
leaking of blood at site
- D/c
- Apply pressure with sterile dressing
- Apply cool compress/ice intermittently for 24 hrs, followed by warm compresses
13
Q
What should you do if a clot forms in your IV line?
A
d/c it! DON’T milk, irregate, aspirate or up the flow rate
14
Q
What should you do for a hemolytic blood transfusion reaction?
A
- Stop transfusion
- Maintain IV access by restarting NS
- Notify HCP
- Supportive care (oxygen, diphenhydramine, airway management)
15
Q
Where is the tip of the catheter for a PICC?
What should you NOT do if your pt has a PICC line?
A
SVC or Brachiocephalic vein
No BP or blood draws from that extremity
16
Q
Difference between a tunneled central catheter and a non-tunnled percutaneous central cath? How frequently do you change dressings?
A
Tunnled = long term use (yrs)
Non-tunnled: short term IV therapy
2-3 x /week
17
Q
Norephinephrine ADRs
A
HA
Palpittaions
Angina
HTN
TISSUE NECROSIS with extravasation
18
Q
What is norephinephrine used for?
What should you monitor for?
What should it be infused with (and what should it NOT be)?
A
Vasoconstriction to increase BP and CO
UOP + BP
Dextrose yes, NS no
19
Q
Dopamine, at a high dose, can be used for what?
What is an early sign of drug excess?
What should always be used with it?
A
Vasoconstriction, increased nyocardial oxygen consumption
HA
Infusion pump
20
Q
Isoproterenol is used for…(4)
Isoproterenol should not be given when?
A
Heart block
Ventricular arrythmyia
Bradycardia
Bronchodilation for asthma and brochospasms
Do not give at bedtime, it interrupts sleep patterns
21
Q
Phenylephrine is used to treat
A
Hypotension (alpha 1 agonist)
22
Q
Dobutamine Hydrochlorie is a _____ stimulator
How is it administered?
What should be monitored when giving this med?
A
Beta 1
Through central venous cath or large peripheral vein with infusion pump
Monitor EKG
I/O
Serum K+
22
Q
Dobutamine Hydrochlorie is a _____ stimulator
How is it administered?
What should be monitored when giving this med?
A
Beta 1
Through central venous cath or large peripheral vein with infusion pump
Monitor EKG
I/O
Serum K+
23
Q
What is milrinone used to treat?
A
Smooth muscle relaxant for severe HF
It’s a positive inotrope
24
Nitroprusside is used for (3)
ADR
Dilation of cardiac veins and arteries
Decreases pre-load and afterload
Increases myocardial perfusion
HYPOTENSION + IICP
25
What does diphenhydramine do?
Blocks effects of histamine on bronchioles, GI tract, blood vessels
26
-sone drugs (ex: Cortisone, Dexamethasone, Prednisone) are generally, what class of medications? What are they treating?
Adrenalcorticoid: Glucocorticoid meds
Use:
- prevention / supression of cell-mediated immune reactors
- addrenal insufficiency
27
Glucocorticoid drugs (-sone):
- Overdosing these meds could lead to _____
- Abrupt withdrawal could lead to _____
- When should these meds be given? + administered with what?
- Stress/surgery means what for these meds?
- What should be consistently checked in adults and then especially in kids?
Cushings sundrome
Addisonian crisis (HA, N/V, papilledema)
Morning, before 9am + antacid
Increase need for steroid doses in times of stress
BP, I/O, weight
Growth in kids
28
Glucocorticoid drugs increases a pt susceptibility to ______.
What electrolyte imbalances can occur?
What about glucose levels?
Infection / slow or poor wound healing + osteoporosis (pathologic fractures) + psychosis
Hypokalemia / Hypocalcemia
Hyperglycemia
29
What is Fludrocortisone given for?
How should it be given?
Class of drug?
What should you watch for as ADRs?
Diet recommendation?
What are nursing considerations?
Adrenal insufficiency
PO with food
Sodium + water retention
Low-sodium, high protein, high-K+ diet
Monitor BP
Monitor serum electrolytes
Daily weight + report of sudden changes to provider
Used with cortisone or hydrocortisone for adrenal insufficiency
30
Atropine uses
Pt ed
Bradycardia / Mydriasis for ophthalmic exam
Anticholinergic effects
Avoid heat
31
Scopolamine is used for
How is it given?
ADRs
motion sickness / vertigo
transdermal patch
Anticholinergic effects
32
Heparin: normal PTT times
How should heparin be administered and how NOT?
Antidote?
20-40 sec (1.5-2.5 x the control without signs of hemorrhage)
IV with pump
SQ
NEVER IM (danger of hematoma)
Protamine sulfate within 30min
33
Low molecular weight heparin is aka _____
How is it administered?
What is the advantage of this med?
Enoxaparin
SQ - NEVER IV or IM
Does not require lab test monitoring
34
Warfarin, monitor what? / whats nml?
Antidote?
PT: 9.5-12
INR: 2-3
Vit K
35
Dabigatran is used to treat
MOA
Stroke
DVT
PE prophylaxis without A Fib
Directly inhibits thrombin
36
What meds inhibit the synthesis of clotting factors? (4)
Heparin
Enoxaparin
Wafarin
Fondaparinux
37
Heparin is used to treat....
Warfarin to treat...
Prophylaxis and treatment of thromboemolic disorders
pulmonary emboli
VTE
MI
Atrial dysrrhythmias
Post cardiac valve replacement
38
A client on anticoag meds should avoid (3)
They should do
IM injections
ASA-containing products
NSAIDs
Soft toothbrush, electric razor, report bleeding gums / petechiae / bruising / epistaxis etc
39
_______ is the med of choice for seizures in young children
What should it be taken with?
What should be monitored
Valproic acid
Food
Monitor PLTs, bleeding time, liver fx
40
With gabapentin, what should you monitor for?
Weight + mood changes
41
Lamotrigine and Topiramate are drugs used for
Anticonvulsants for seizures
42
Phenelzine sulfate
Isocarboxacid
Tranylcypromine
are what types of drugs?
ADRs?
MAOIs
HTN crisis when taken with tyramine foods: aged cheese, salami, figs, bananas, raisins, beer, red wine)
OR
ephedrine meds (OTCs)
43
Fluoxetine, Paroxetine, Sertraline, Citalopram are what type of drugs?
SSRIs
44
Which type of anti-depressants have anticholinergic effects?
Tricyclics (Amitriptyline, Imipramine)
45
OPD: Lispro
O: 15-30 min
P: 0.5 - 1.5 hrs
D: 3-5 hrs
46
OPD: Aspart
When is the time of adverse reaction?
O: 15-30 min
P: 1-3 h
D: 3-5 h
mid-morning: trembling / weakness
47
OPD: Regular Insulin
When is the time of adverse reaction?
O: 30-60 min
P: 1-5 h
D: 6 - 10 h
Mid-morning / mid-afternoon
48
Isophane NPH OPD
When is the time of adverse reaction?
O: 1-2 h
P: 4-12 h
D: 16 h
Early evening (weakness, fatigue)
49
For rapid acting insulin (Aspart, Lispro, Gluisine), when should the client eat after injection?
5-15 min after
50
For regular insulin, when should it be given before meals?
20-30min prior
51
Which type of insulin can be given after meals?
NPH
52
Examples of sulfonylurea drugs: (3)
When are they used?
Glimepride
Glipizide
Glyburide
Used if there is some pancreas beta-cell fx, to stimulate release of insulin
53
Metformin is a ____ type of drug.
How does it work?
When is it NOT given?
What can it lead to adversely?
Biguanide
Decreased glucose production by liver (DOES NOT effect the pacreas)
NOT for renal impairment pts
Avoid alcohol / can lead to lactic acidosis
54
How to alpha glucosidase inhibitors work?
Names of drugs?
When are these meds taken?
Delay digestion of carbs
Acarbose
Miglitol
Taken immediately before a meal
55
Within ____ min you can repeat a dose of glucagon for a hypoglycemic pt.
15
56
Propranolol is a _____ type of drug.
What should you monitor and asses for?
Beta blocker
Apical HR
Cardiac rhythm
BP
Asses: SOB and wheezing
- fatigue / sleep disturbance
- Apical rate for 1 min prior to administration
57
ADRs of BBs like Propranolol (4)
Bradycardia
Hypotension
Fatigue/sleep distrubances
BRONCHOSPASM
58
Amiodarone ADR (6)
Hypotension
Bradycardia./ AV block
Msk weakness
tremors
Photosensitivity / photophobia
Liver tox
59
Verapamil and Diltiazem are _____ types of drugs.
What should you watch for as a nurse?
CCBs
Apical HR + BP
Orthostatic precautions
Instruct clients to report s/s of HF to PCP
60
Ondansetron is a ______ type of med.
ADRs?
antiemetic
HA
Sedation
Diarrhea / Constipation
Transient elevation in liver enzymes
61
Metoclopramide is a ____ type of med.
What should the pt avoid when taking this med?
When should they take it?
ADRS
Antemetic
Avoid actvities that require mental alertness
Take before meals
Take 30 min prior to chemo
Use with tube feeding to decrease risk of aspiration
Anxiety / drowsy
EPS
Dystonic reactions
62
Promethazine is a _____ type of drug. What is it used to treat? What should be avoided when taking it?
Anti emetic
Motion sickness
Avoid:
- alterness activitive
- alcohol
- other CNS depressants
63
Amphotericin ADRs
GI upset
Hypokalemia (induced msk pain)
CNS disturbances in sight and sound
Seizures
Skin irriation / thrombosis if IV infiltrates
64
When a pt is taking amphoterecin, what as the nurse should you be monitoring for? (3)
Hypokalemia
Injection sight (irritation / thrombosis)
Report fever / nervous system dysfunction
65
Antifungal meds (4)
Amphoterecin
Nystatin
Fluconazole
Ketoconazole
66
What nursing considerations for anti-fungals? (3)
Administer with food to decrease GI upset
Small, freq meals
Check hepatic fx
67
3 anti-gout meds
Colchicine
Probenecid
Allopurinol
68
What are the ADRs for anti-gout meds (4)
Aplastic anemia
Agranulocytosis
Renal calculi
GI irritation (GIVE WITH MEALS)
69
Antihistamine drug names (4)
Chlorpheniramine
Diphenhydramine
Promethazine
Loratidine / Certirizine / Fexofenadine
70
ADRs of antihistamines (generally) (6)
Depression
Nightmares
Sedation
Drymouth
GI upset
Bronchospasm
71
How should antihistamines be taken?
What other nursing advice?
Take with food
Good oral care (dry mouth)
Caution with alert tasks
Avoid alocohol
72
Aminoglucoside meds (3 names) - action?
Gentamicin
Tobramycin
Amikacin
Bacteriocidal (gram neg)
73
ADRs and nursing considerations for Aminoglycosides
Ototoxicity
Nephortoxicity
Anorexia / N/V / Diarrhea
Check 8th cranial nerve (hearing)
Check BUN / Cr
Encourage fluids + sm freq meals
74
________ drug has a cross allergy with PCN.
What should you monitor for in a pt taking this med?
Cephalosphorins (Cefoxitin, ceftriaxon, cefepime,fosamil)
Renal / hepatic function
Thrombophlebitis
75
2 fluoroquinolones drug names
What do they do?
Ciprofloxacin
Levofloxacin
Bacteriocidal (gram neg)
76
Ciprofloxacin and Levofloxacin: prior to giving these to a pt you should do _______.
What should you encourage of pts on these drugs?
When should they take them?
Culture + sensitivity
fluids
Take 1 hr before or 2hr after meals with a glass of water
77
What are the ADRs of Ciprofloxacin and Levofloxacin
Elevated BUN / Cr
Elevated AST/ ALT / Alkaline phosphatase
Decreased WBC and hematocrit
Rash
Photosensitivity
Achilles tendon rupture
78
Which type of drug can lead to achilles tendon rupture?
Fluoroquinoles (Cipro and Levo)
79
What drug is used for resistant staph infections and enterocoloitis due to C/diff?
Vancomycin
80
ADRs Vanco (3)
Nephrotoxicity
Ototoxicity
Thrombophlebitis
81
How should Vanco be administered?
What ADRs to watch for?
IV
Extravization
Red man syndrome
Superinfections: sore throat, fever, fatigue
** Nephrotoxicity
*** Ototoxicity
82
Why is Clindamycin used? (2)
What should be monitored?
Staph / Strep
Persistant vomiting
Diarrhea
Abd cramping
Superinfections
83
Erythromycin and Azithromycin should be taken via what route and with or without meals?
What should be monitored?
Oral
1 hr before or 2-3 hrs after meals with full glass of water
Liver function
84
PCN drugs are effective at fighting...
gram positive orgs
syphilis
Lyme
85
Sulfa drugs (Sulfasalazine) are used to treat (8)
Ulcerative colitis
Chrons
Ottitis media
Conjunctivitis
Meningitis
Toxoplasmosis
UTIs
RA
86
When taking sulfa drugs what should you advise pts to do?
Take with water
Protect from exposure to sun light
Good mouth care
87
Tetracycline drug names (3)
Doxycycline
Minocycline
Tetracycline
88
Tetracycline drugs should not be taken with...
Monitor for _________
Advise them to use ______
Not safe in ______
Antacids, milk, iron preparations
(Also take 1h prior to meals or 2-3 hrs after meals)
Renal fx
Extra contraceptive methods (danger to fetal teeth dev)
Pregnancy
89
ARB drug names
- sartans
Losartan
Valsartan
90
ACE-i drug names
Indications? (2)
-pril
Lisinopril
Captopril
Enalapril
HTN
CHF
91
How should ACE-i be taken?
1 hr prior to meals or 2-3 hrs after meals
92
Which type of med would give a pt a persistant dry non-productive cough?
ACE-i (ex: Lisinopril)
93
Alpha-1 adrenergic blocker drug names.
What do they treat?
When should they be administered?
- zosin
Doxazosin
Terazosin
HTN
BPH
Raynaud's
Administer at bedtime to avoid fainting
94
BBs are used to treat (7)
HTN (with diuretics)
Angina
SVT
Recurrant MI
Propanolol: migranes and stage fright
HF
95
Nursing considerations for BBs
DO NOT d/c abruptly, taper over 2 weeks
Take with meals
FOR DIABETICs: masks s/s of hypoglycemia so monitor BG levels closely
96
Names of CCBs (4)
Nifedipine
Verapamil
Diltiazem
Amlodipine
97
What type of anti-HTN is contraindicated in pts with heart blocks?
CCBs
98
Pt is on a CCB. What should they avoid? What should you monitor for?
Grapefruit juice
s/s of HF and if BP is less than 90/60
99
Clonidine and Methyldopa are used to treat what?
What should you monitor for?
HTN
Fluid retention and ortho hypo
** also don't d/c abruptly
100
Where should a clonidine patch be applied?
Upper outer arm / anterior chest (nonhairy areas)
101
When should methyldopa be taken?
Bedtime to minimize daytime drowsiness
102
If the apical pulse of a pt on atenalol is less than ____ hold the drug and call the HCP. What will this drug mask the s/s of ?
60
Hypoglycemia
103
What are bile acid sequestriant drug names?
What are they treating and how?
When should they be administered?
What should a pt report immediately when on these meds?
Cholestyramine
Colestipol
HMG-COA reductase inhibitors
Folic acid dervitiates
Nicotinic acid
Decreases cholesterole by increasing the loss of bile acid through feces
Admiister 1 h before or 4-6 hrs after other meds
Report constipation
104
What do statin drugs do?
When should they be taken?
What should be reported immediately to a care provider?
What should pts avoid on this med?
Decrease LDL cholesterol levels
Take with food and at night
Muscle pain w/ fever and malaise
No grapefruit juice
105
Niacin drug does what?
What ADRs could it cause?
Decreases total cholesterol
Flushing for first 2 weeks
HyperG
Liver damage
106
Methotrexate can be used to treat (4)
ALL
RA
Colon, breast, stomach, pancreas cancers
SCA
107
When giving bone marrow suppression meds what should you monitor for?
What should be avoided?
What should you do at venipuncture sites?
Bleeding gums, bruising, dark stools, etc
IM injections and rectal temps
Pressure
108
Anti-Parkinson drug names (5)
Trihexyphenidyl
Levodopa
Bromocriptine
Carbidopa - Levodopa
Amantadine
109
What are the nursing considerations for parkinson's meds? (monitor for ____, don't take _____, avoid ______)
Monitor: urinary retention
Don't take a lot of B6
Avoid CNS depressants
110
Ticlopidine and Clopidogrel both do what?
Prevent platelet aggregation
111
Abciximab is what type of med?
Anti-PLT
112
ASA is a ______ type of drug.
You should watch for .....
Give with .....
Contraindications (3)
anti- PLT (also anti-inflammatory, analgesic and antipyretic) - salicylate
Bleeding gums, black stools, bruising
Milk, water, food
GI disorders
Severe anemia
Vit K deficiency
113
When are anti-PLT meds given?
Venous thrombosis
PE
CVA
Post - cardiac surgery
ACS
114
Chlorpromazine is what type of drug? What should pts be aware of with this med?
Typical antipsychotic
Photosensitivity
Hypotension
Sedation
115
Which has less EPS: Haldol or Risperidone?
Risperidone
116
What types of antipsychotic meds can lead to QT prolongation?
Aripiprazole
Clozapine
Olanzapine
Ziprasidone
117
Define:
Akathisia
Dyskinesia
Dystonia
Tardive dyskinesia
Akathisia: motor restlessness (foot tapping, pacing)
Dyskinesia: abnormal voluntary movements
Dystonia: abnormal muscle tone--> spasm in face and neck and tongue
Tardive dyskinesia: involuntary movement of mouth, tongue, extremities, chewing motions, sucking, tongue thrust
118
Early signs of EPS to watch for in pts on anti-psychotic meds
tight jaw
Stiff neck
Swollen tongue
119
What is neuroleptic malignant syndrome and what is it associated with? What should you do if your pt develops this?
Rigidity
Fever
autonomic dysfunction
seizures/coma
ADR of antipsychotic meds
Immediately withdraw anti-psychotics
Control hypertheermia
Dantroline
Bromocriptine
120
ASA is contraindicated in what pt population and why?
<21 yrs old d/t risk of Reyes syndrome
Also contraindicated in pts with bleeding disorders d/t anticlotting activity
121
Hyperthyroidism med names
Methimazole
Potassium or radioactive iodine
122
Hypothyroidism meds
Levothyroxine
Liothyronine
123
ADR Isoniazid
Hepatitis
Peripheral neuritis
Rash
Fever
124
Ethambutol ADR
Optic neuritis
125
Rifampin ADR
Hepatitis
Fever
126
Streptomycin ADR (also what does it treat?)
Nephrotoxicity
VIII nerve damage (hearing)
TB
127
Overall, with TB meds, what is it important to watch for?
Liver damage / Hepatitis
128
When a TB pt is on meds, how long do they need to wear a mask when in crowds?
Until 3 sputum cultures are negative (which means they are no longer infective)
129
Anti-tussive and Expectorant drug names
Dextromethorphan
Guifenesin
130
Zidovudine and Didanosine are used to treat ______
HIV
131
-clovir meds treat ....
HSV
132
What meds treat Influenza A or B
Amantadine
Oseltamivir
Zanamivir
133
What should be monitored in children taking ADHD meds like: Methylphenidate?
Growth rate
134
3 bipolar drug names
Lithium
Carbamazepine
Divalproex
135
s/s of lithium intoxication
vomiting
diarrhea
ataxia
msk weakness
136
What is the initial blood target level for lithium?
Maintenance level?
1-1.5
0.8 - 1.2
137
Do bipolar meds treat the depressive episodes?
What are the general ADRs of these meds?
No just manic
Tremors
Polyuria
Polydipsia
138
What drugs help to treat postmenopausal osteoporosis?
Alendronate
Risendronate
Ibandronate
- DRONATE
139
Digoxin is used to treat _______
How does it work?
HF
Dysrrhythmias
Increases the force of myocardial contraction and slows the. HR by stimulating the vagus nerve and blocking the AV node
140
What food should you advice pts on digoxin to take?
Potassium foods
141
Sucralfate can help treat....
Duodenal ulcer
142
Thiazide diuretic drug names
What should you encourage of pts on these meds?
What electrolyte should you monitor closely?
What should you do daily with this pt?
Hydrochlorothiazide
Chlorothiazide
Eat potassium rich foods
K+
Daily weights
143
Furosemide is a ____ type of drug.
Over ____ mins you should give this drug via IV
Encourage what type of foods?
Loop diuretic
1-2 min
Potassium rich
144
Mannitol is a _____ type of drug
Osmotic diuretic
145
Drug names to treat duodenal ulcers
Cimetidine
Ranitidine
Famotidine
-IDINE
146
_____ drug prevents rejection of transplanted organs
Cyclosporin
147
A SL dose of nitroglycerin can be repeated every ____ mins for a total of ____ doses.
5 min 3x
148
Indomethacin
Naproxen
Celecoxib
Ketorolac
Are all what type of med?
NSAID
149
Thrombolytic med names, what are they used for?
Reteplase
Alteplase
Tenectaplase
MI w/n first 6 hrs of symptoms, or thrombolic strokes or PE (alteplase)
150
Meds to AVOID with grapefruit juice
Buspirone
Midazolam
Amiodarone
Carmazepine
CCBs
Sildenafil
Cyclosporine
SSRIs
Satins
Dextromethorphan
151
Terazosin can be used to treat
When should it be given?
urinary urgency, hestitancy and noturia
Night time to decrease risk of ortho hypo
152
If anaphylaxis occurs, what med do you want to give? How soon after the first dose can you do a repeat done?
Epinephrine
15-20 min after
153
SJS s/s
Dark red papules that dont itch or hurt
