Learn Smart Pharmacology 1 Flashcards
Teaching parents of a child w/ Rx for valproic acid (Depakene) for seizures. Child must return to clinic in 2 wks for WOTF tests? (MM)
a. BUN
b. platelet count
c. Aspartate aminotransferase (AST)
d. urinalysis
e. Alanine aminotransferase (ALT)
b, c and e. A major SE of valproic acid is on the hematologic system, causing thrombocytopenia and prolonged bleeding time. The drug can also cause severe hepatotoxicity especially in young children. Thus AST and ALT (identifies liver damage) must be monitored closely during the 1st few months of therapy.
RN caring for p receiving heparin for DVT prophylaxis. RN correctly delivers the heparin by?
a. using the SC sites in the abdomen
b. administering the injection using the z-track method into the thigh
c. massaging the injection site after injection
d. administering the injection with a 22 gauge needle
A. heparin is injected into the fatty layers of the abdomen. It is not injected into thigh muscles, and it should be given with a 25 gauge or smaller needle to decrease the risk for hemorrhage. Massaging the site afterwards can also increase hemorrhage risk. Apply gentle pressure only.
RN should anticipate giving wotf meds for a p who is scheduled to have contraction stress test (CST)?
a. oxytocin (Pitocin)
b. Nifedipine (Procardia)
c. Betamethasone (Celestone)
d. Rho (D) immune globulin (RhoGAM)
a. Oxytocin is administered to stimulate contractions during a CST. Nifedipine is a tocolytic med that is given to stop UCs in preterm labor. Betamethasone is given in the intrapartum period to promote lung dvlpmt if early delivery is expected. RhoGAM is given in the antepartum period to Rh-negative mothers to prevent hemolytic disease of the NB.
RN caring for p w/ PUD. WOTF meds should be given to alleviate a h-ache?
a. ibuprofen (Advil)
b. Naproxen (Naprosyn)
c. Aspirin (Ecotrin)
d. Acetaminophin (Tylenol)
d. Acetaminophen is an analgesic used for mild to moderate pain. It is appropriate for p’s with PUD bc it doesn’t affect blood coagulation or increase the risk for GI bleeding. Ibuprofen and Naproxen are both NSAIDs, which are CI’d for p’s w/ PUD or active bleeding disorders due to the increased risk of GI blds. Aspirin is also CI’d bc of the risk of GI irritation and hemorrhage.
RN is caring for a p who is receiving heparin IV therapy. The morning aPTT is 90 seconds (control of 26). RN should FIRST?
a. administer protamine sulfate
b. turn off the infusion
c. contact the primary HCP
d. request a repeat blood test
b. turn of the infusion. An aPTT of 90 seconds is 1.5-2 times the normal value. The greatest risk to the p is hemorrhage so the RN should turn off the infusion to prevent giving any more heparin. C and D are necessary but should not be done first. A may be necessary to reverse the effects of heparin but it is not the first action
Rn should know that metoclopramide (Reglan) is CI’d for a p who?
a. is receiving chemo
b. has an intestinal obstruction
c. has glaucoma
d. is vomiting after a colon resection
b. Reglan promotes gastric emptying so it shouldn’t be given to a p with a bowel obstruction. Reglan is used to tx vomiting r/t chemotherapy and to control postop vomiting. Reglan is not CI’d in p’s w/ glaucoma
After taking erythromycin PO for 7 days, a p develops oral candidiasis. RN recognizes that this is most likely r/t wotf?
a. allergic response
b. superinfection
c. synergistic rxn
d. erythromycin toxicity
b. superinfection. The candid fungus is normally present in the mouth. The antibiotic effect of erythromycin allows the fungus to grow out of control which results in a superinfection. Candidiasis is not an allergic or synergistic response. Erythromycin toxicity is manifested by hearing loss (ototoxicity) and hepatotoxicity
A p w/cirrhosis is Rx’d lactulose (Cephulac) PO. For wotf actions should the RN administer lactulose?
a. to increase BP
b. to prevent bleeding from esophageal varices
c. to decrease HR
d. to reduce serum ammonia levels
d. Cephulac is a laxative that is given to promote the excretion of ammonia. Ammonia levels are increased in lever failure, producing hepatic encephalopathy or coma. Lactulose discourages the growth of bacteria, traps ammonia in the gut, and expels ammonia from the colon. It has no effect on BP/HR/bleeding
P. is Rxd ergotamine tartrate (Ergomar). RN should recognize that ergotamine tartrate is indicated for?
a. HTN
b. migraine headaches
c. ulcerative colitis
d. anemia
b. migraine headaches- ergotamine tartrate blocks alpha-adrenergic receptors in the cranial peripheral vascular smooth muscle to cause vasoconstriction of dilated cerebral blood vessels. Ergotamine tartrate causes vasoconstriction, thus it is CI’d for p’s with HTN. It is also CI’d w/ anemia.
RN is reviewing the morning CBC and diff. for a p taking filgrastim (Neupogen). In evaluating the p’s response to filgrastim, the RN should review the?
a. erythrocyte count
b. neutrophil count
c. lymphocyte count
d. thrombocyte count
b. neutrophil count - Filgrastim is used to raise the absolute neutrophil count (it stimulates proliferation of neutrophils) in p’s who have neutropenia r/t chemo or any other cause. It has no effect on RBCs, lymphocytes or platelets
RN caring for p Rxd amphotericin B (Fungizone). WOTF should the RN recognize as the best indicator of renal function?
a. serum K+
b. daily wts
c. I&O
d. Serum creatinine levels
d. Creatinine levels are the most accurate indicator of renal function. The levels should be monitored q-other-day as the dosage of amphotericin B is increased to optimal level and then weekly until the drug is d/c’d. If creatinine increases to 3 mg/mL, the dose should be decreased or d/c’s until renal function improves. Amphotericin is an antifungal drug that binds to sterols in fungal cell membranes.
Older adult p w/ depression is Rx’d the TCA amitriptyline (Elavil). WOTF dx tests will be ordered prior to starting this med?
a. CBC
b. EEG (electroencephalogram)
c. ECG
d. liver function profile
c. ECG - older adults have an increased risk for experiencing CV SEs of amitriptyline. Thus, an ECG will show baseline cardiac functioning. Amitriptyline does not cause liver dysfunction or hematologic changes. It does not pose any risk for seizures
Teaching to parents of child who is Rx’d cromolyn sodium (Intal) via metered dose inhaler. WOTF ind need for further teaching?
a. I will give my child a dose as soon as wheezing starts
b. my child needs to do a mouth rinse after using the inhaler.
c. my child should breathe in slowly while depressing the canister
d. if my child has difficulty breathing in the dose, a spacer should be used.
a. Cromolyn sodium is a mast cell inhibitor that has a very slow onset and is used only prophylactically. It is not a rescue medicine for acute asthma attacks. Rinsing the mouth after helps alleviate mouth/throat irritation c/b Intal. Breathing in slowly while depressing the canister is the correct way to use a MDI. A spacer allows p’s to receive inhalation medication in subsequent breaths
RN ax-ing p taking tamoxifen (Nolvadex). RN should recognize that tamoxifen is an?
a. antimicrobial
b. anti-estrogenic
c. androgenic
d. anti-inflammatory
b. anti-estrogenic. Tamoxifen is used to tx breast CA in both pre- and post- menopausal women. It has been shown to delay recurrences also. Tamoxifen has no antimicrobial or anti-infla effect. It is not androgenic, androgens are the male hormones used to tx breast CA
While providing teaching to a p Rx’d hydrochlorothiazide (Oretic) for HTN, the RN should tell the p to take the medication:
a. when edema is present
b. at bedtime
c. on an empty stomach
d. in the am
d. in the am - taking diuretics in the morning allows for diuresis during the day without interfering with sleep. The drug should be taken on a regular basis (qday), not prn, and should be taken with food to minimize GI disturbances.
