Medication Administration Competency

Question 1

acetaminophin

Answer 1

Trade Name: Tylenol

Route: oral
Therapeutic effects: analgesia, antipyresis

Indications: treatment of mild pain, fever

Contraindications: previous hypersensitivity; severe hepatic impairment or active liver disease

Side Effects/Adverse Reactions: agitation in children; hepatotoxicity in higher doses; renal failure in higher doses and chronic use

Nursing considerations: Assess pain type, location, and intensity prior to and 30-60 mins following administration; assess fever and presence of associated signs (diaphoresis, tachycardia, and malaise); and assess overall health status and risk of developing hepatotoxicity.

Patient teaching: Take exactly as directed and do not exceed recommended amount (may lead to hepatotoxicity, renal, or cardiac damage. Avoid alcohol and concurrent usage with salicylates or NSAIDs for more than a few days. Ensure caregivers know how to determine correct dosage for a child and how to measure.

Question 2

acetylsalicylic acid (ASA)

Answer 2

Trade Name: Aspirin

Route: Oral

Therapeutic Effects: antipyretic; nonopioid analgesic.

Indications: Fever, mild to moderate pain, prophylaxis of transient ischemic attacks and MI, inflammatory disorders (RA, OA)

Contraindications: hypersensitivity; bleeding disorders or thrombocytopenia; may increase risk for children of Reye’s syndrome.

Side Effects: dyspepsia, epigastric distress, nausea.

Nursing Considerations: Assess pain and limitation of movement (type, location, intensity) before and after the peak of administration. Assess fever and noted associated signs (diaphoresis, tachycardia, malaise, chills).

Patient Teachings: Take with full glass of water and remain upright for 15-30 mins. Avoid alcohol to minimize gastric irritation. Avoid taking w/ acetaminophen or NSAIDs for more than a few days unless directed by clinician to prevent analgesic nephropathy.

Question 3

alprazolam

Answer 3

Trade Name: Xanax

Route: Oral

Therapeutic Effects: Anti-anxiety agent, benzodiazepine, Schedule IV drug.

Indications: Generalized anxiety disorder, panic disorder, anxiety associated with depression.

Contraindications: Hypersensitivity; severe uncontrolled pain; pre-existing CNS depression.

Side Effects: Dizziness, drowsiness, lethargy, paradoxical excitation, physical or psychological dependence, tolerance.

Nursing Considerations: Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically during therapy. Assess pt for drowsiness, light-headedness, and dizziness (should disappear as therapy progresses). Prolonged high dose therapy may lead to dependence. Assess Geri patients for fall risks.

Patient Teaching: Take meds as directed and do not skip or double up (if missed, take w/in 1 hr or just take next regular dose). Do not take more than is prescribed or share with others. May cause dizziness or drowsiness so wait to see effect before driving etc.

Question 4

amlodipine

Answer 4

Route: oral

Therapeutic effects: antihypertensive

Indications: Hypertension, angina pectoris, vasospastic (Prinzmetal’s) angina.

Contraindications: Hypersensitivity, systolic BP <90 mmHg

Side Effects: Dizziness, fatigue, bradycardia, hypotension

Nursing Considerations: Monitor BP and pulse before therapy, during dose titration, and after therapy. For Angina, assess location, duration, intensity, and precipitating factors of pain. Monitor intake/output ratios and daily weight - assess for heart failure.

Patient Teaching: Take meds as directed and take missed doses w/in 12 hrs or just go to next dose. Teach pt to monitor pulse and to contact clinician if <50 bpm. And teach pt and family proper technique for monitoring BP (weekly).

Question 5

atorvastatin calcium

Answer 5

Trade Name: Lipitor
Aka: HMG-CoA Reductase Inhibitors

Route: Oral

Therapeutic Effects: Lipid-lowering agent; HMG-CoA Reductase Inhibitors

Indications: adjunctive management of primary hypercholesterolemia and mixed dyslipidemias. Primary prevention of cardiovascular disease for patients with multiple risk factors for coronary heart disease or type 2 diabetes.

Contraindications: Hypersensitivity, active liver disease, avoid during pregnancy/lactation.

Side Effects: abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes.

Nursing Considerations: Obtain dietary history (fat consumption). Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 wk of therapy, and periodically thereafter.

Patient Teaching: take meds as directed. Avoid more than 200 mL of grapefruit juice. Meds should be in conjunction with diet restrictions (fat, cholesterol, carbs, alcohol), exercise, cessation of smoking. F/u exams to monitor effectiveness and side effects important.

Question 6

dextromethorphan

Answer 6

Trade name: Robitussin, Vicks

Route: Oral

Therapeutic Effects: Allergy, cold, cough, antitussive.

Indications: symptomatic relief of coughs (viral upper respiratory tract infections) - particularly for chronic nonproductive cough.

Contraindications: Hypersensitivity, patients taking MAO inhibitors or SSRIs, chronic PRODUCTIVE coughs.

Side effects: dizziness and sedation, nausea

Nursing considerations: Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Unless contraindicated, maintain fluid intake of 1500-2000 mL to decrease viscosity of bronchial secretions.

Patient Teachings: Instruct pt to cough effectively (sit up, take deep breaths before cough). Minimize exposure to irritants/humidifier. May cause dizziness - avoid driving etc until known response.

Question 7

diphenhydramine

Answer 7

Trade name: Benadryl, Unisom

Route: oral

Therapeutic Effects: allergy, cold, cough, antihistamine, antitussive

Indications: relief of allergic symptoms caused by histamine relief. Mild nighttime sedation.

Contraindications: Hypersensitivity; acute attacks of asthma; geriatrics - anti cholinergic effects (delirium, confusion, dizziness, dry mouth)

Side Effects: drowsiness, dizziness, headache, paradoxical excitation (esp children)

Nursing Considerations: Assess degree/nature/frequency of allergic rhinitis, cough, related symptoms. Maintain fluid intake of 1500-2000 mL to decrease viscosity of bronchial secretions.

Patient Teachings: take meds as directed. Take precautions w/ drowsiness. May cause dry mouth (oral rinses, sugarless gum or candy).

Question 8

docusate sodium

Answer 8

Trade name: Colace

Route: Oral

Therapeutic effects: laxative, stool softener

Indications: prevention of constipation

Contraindications: hypersensitivity, abdominal pain, nausea, vomiting.

Side effects: throat irritation, mild cramps, diarrhea, rashes.

Nursing considerations: assess for abdominal distention, presence of bowel sounds, and unusual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Patient Teaching: only for short term therapy. Use w/ increasing bulk of diet, fluid intake, mobility. Don’t use laxatives when abdominal pain, nausea, vomiting, or fever is present.

Question 9

famotidine

Answer 9

Trade name: Pepcid

Route: oral

Therapeutic effects: antiulcer agent, histamine H2 antagonist

Indication: short term relief of active duodenal ulcers and benign gastric ulcers or maintenance therapy once healed. Management of GERD, treatment of heartburn, acid indigestion, and sour stomach.

Contraindications: Hypersensitivity

Side effects: confusion, dizziness, drowsiness, constipation.

Nursing considerations: assess for epigastric or abdominal pain and frank or occult blood in stool, emesis, or gastric aspirate.

Patient teachings: take as directed. Smoking interferes with effectiveness. Avoid foods and alcohol that cause GI irritation and increase fluid, fiber, exercise. May cause drowsiness or dizziness.

Question 10

ferrous sulfate

Answer 10

Iron supplements, 30% elemental iron

Route: oral

Therapeutic effects: antianemics, iron supplement

Indications: prevention/treatment of iron-deficiency anemia

Contraindications: evidence of iron overload, anemia not due to iron deficiency

Side effects: nausea, constipation, dark stools, diarrhea, epigastric pain.

Nursing considerations: assess nutritional status and dietary history to determine cause of anemia and need for teaching. Monitor hemoglobin, hematocrit, and reticulocyte values prior to and every 3 weeks after during the first 2 months of therapy, and periodically after.

Patient teachings: explain purpose of iron therapy; follow high iron diet. Stools may become dark green or black, but harmless. Comply with medication regimen.

Question 11

furosemide

Answer 11

Route: oral

Therapeutic effects: diuretic

Indications: edema due to heart failure, hepatic impairment, renal disease, hypertension

Contraindications: hypersensitivity; hepatic coma; anuria

Side effects: dehydration, hypocalcemia, hypochloremia, hypokalemia; hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

Nursing considerations: assess fluid status (monitor daily weight, intake, and output ratios and location of edema, lung sounds, skin turgor, and mucous membranes). Notify clinician if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs. Monitor BP and pulse before and after drug administration. Monitor Rx refills for compliance.

Patient Teachings: take as directed, no double dosing. Change positions slowly to minimize orthostatic hypotension and be mindful of things that lead to dehydration (alcohol, exercise in hot weather, etc). If gain more than 3 lbs in one day contact clinician.

Question 12

gabapentin

Answer 12

Route: Oral

Therapeutic effects: analgesic adjunct, therapeutic anticonvulsant, mood stabilizer.

Indications: partial seizures (adjunct treatment - IR only), postherpetic neuralgia, restless leg syndrome.

Contraindications: hypersensitivity

Side effects: confusion, depression, dizziness, drowsiness, ataxia

Nursing considerations: monitor closely for notable changes in behavior that could indicate emergence or worsening of suicidal thoughts or behavior. Seizures - note the location, duration, and character. Postherpetic neuralgia and neuropathic pain - assess, COLDSPA.

Patient teachings: take only as directed - if on 3x/day, no more than 12hrs between doses. Take missed doses ASAP; if less than 2 hrs until next dose, take the dose immediately and then take the next dose 1-2 hours later, then resume regular schedule. Do not discontinue abruptly; may cause increased frequency of seizures. May cause dizziness or drowsiness. Contact clinician if change in mood.

Question 13

guaifenesin

Answer 13

Route: oral

Therapeutic effects: allergy, cold, cough, expectorant

Indications: coughs associated with viral upper respiratory tract infection.

Contraindications: hypersensitivity

Side effects: dizziness, headache, nausea, diarrhea

Nursing considerations: Assess lung sounds, frequency and type of cough, and character of bronchial secretions periodically. Maintain fluid intake of 1500-2000 mL/day to decrease viscosity of secretions.

Patient teachings: Effective coughing - sit up, deep breaths, then cough. Might cause dizziness - driving safety. Limit irritants, hard candy to alleviate discomfort.

Question 14

hydrochlorothiazide

Answer 14

Route: oral

Therapeutic effects: antihypertensive, diuretic

Indications: management of mild to moderate hypertension. Treatment of edema associated with: heart failure, renal dysfunction, cirrhosis, glucocorticoid therapy, estrogen therapy.

Contraindications: hypersensitivity, anuria.

Side effects: hypokalemia, dehydration, hypovolemia.

Nursing considerations: monitor BP, intake, output, and daily weight and assess feet, legs, and sacral area for edema daily. Assess pt, esp if takes digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Notify clinician if these signs of electrolyte imbalance occur (digoxin also potassium depleting). If hypokalemia occurs, considerations may be given to potassium supplements or decrease dose of diuretic.

Patient Teachings: Take med same time each day, no double dosing. Pt monitor weight biweekly. Slowly change positions - orthostatic hypotension (might be worse with alcohol). Weekly BP.

Question 15

ibuprofen

Answer 15

Route: oral

Therapeutic effects: antipyretic, antirheumatic, nonopioid analgesic, nonsteroidal anti-inflammatory agent.

Indications: treatment of mild to moderate pain, fever, inflammatory disorders, dysmenorrhea.

Contraindications: Hypersensitivity, history of recent MI, severe heart failure.

Side effects: headache, constipation, dyspepsia, vomiting.

Nursing considerations: assess pain/range of motion prior to and 1-2 hours after administration. Monitor fever. Assess for GI bleeding, renal dysfunction, and hepatic impairment.

Patient Teachings: take w/ full glass of water and remain upright for 15-30 mins after. Avoid alcohol, aspirin, acetaminophen. Do not take more than 10 days for pain or 3 days with a fever without consulting clinician.

Question 16

levothyroxine

Answer 16

Route: oral

Therapeutic effects: hormone - thyroid preparation

Indications: thyroid supplementation in hypothyroidism. Treatment or suppression of euthyroid goiters. Adjunctive treatment for thyrotropin-dependent thyroid cancer.

Contraindications: hypersensitivity, recent MI, hyperthyroidism.

Side effects: usually only seen when excessive doses cause iatrogenic hyperthyroidism.

Nursing Considerations: assess apical pulse and BP prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain.

Patient Teachings: take meds every day, same time, take missed dose ASAP unless almost time for next dose. If more than 2-3 doses missed, notify clinician. Does not cure hypothyroidism - it provides a supplement and therapy is for life. Contact clinician: headache, nervousness, diarrhea, excessive sweating, chest pain increased pulse rate, palpitations.

Question 17

lisinopril

Answer 17

Route: oral

Therapeutic effects: antihypertensive, ACE inhibitor

Indications: Management of hypertension, reduction of risk of death or developing heart failure following MI.

Contraindication: hypersensitivity; history of angioedema with previous use of ACE inhibitors.

Side effects: hypotension, cough, taste disturbances.

Nursing considerations: hypertension - monitor BP and pulse frequently during initial dose and periodically during therapy. Assess patient for signs of angioedema.

Patient teachings: Take meds as directed; take missed dose ASAP; do not double up. Avoid salt substitutes or foods containing high levels of potassium or sodium. Take care with orthostatic hypotension contributors and potential dizziness.

Question 18

loratadine

Answer 18

Trade Name: Claritin

Route: Oral

Therapeutic effects: antihistamine

Indications: relief of symptoms of seasonal allergies; management of chronic idiopathic uticaria; management of hives.

Contraindications: hypersensitivity

Side effects: drowsiness or dizziness. Rare - confusion, dry mouth, GI upset.

Nursing considerations: assess allergy symptoms before and periodically during therapy. Assess lung sounds - 1500-2000 mL liquids to decrease viscosity of secretions.

Patient teachings: take as directed; may cause drowsiness or dizziness; if dry mouth use good oral hygiene, sugarless gum/candy, rinsing mouth

Question 19

losartan

Answer 19

Route: oral

Therapeutic effects: antihypertensive, angiotensin II receptor antagonist

Indications: management of hypertension; treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension.

Contraindications: hypersensitivity; concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment.

Side effects: dizziness, hypotension

Nursing considerations: assess BP (lying, sitting, standing) and pulse periodically during therapy; monitor refills for adherence; assess for signs of angioedema.

Patient teachings: keep taking meds even if feeling well and take doses at same time each day. Avoid salt substitutes containing potassium or food containing high levels of potassium or sodium. Avoid sudden changes in position, use of alcohol, hot weather, standing for long periods bc of orthostatic hypotension. Be cautious of dizziness. If swelling occurs, call clinician.

Question 20

metformin

Answer 20

Route: oral

Therapeutic effects: antidiabetic

Indications: management of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemics.

Contraindications: hypersensitivity, metabolic acidosis including diabetic ketoacidosis, severe renal impairment.

Side effects: abdominal bloating, diarrhea, nausea, vomiting.

Nursing Considerations: when combined with sulfonylureas, observe for signs and symptoms of hypoglycemic reactions. If pt who has been on metformin develops illness - assess for ketoacidosis or lactic acidosis and if present, discontinue immediately and treat acidosis.

Patient Teachings: Take every day at the same time; control hyperglycemia but does not cure diabetes. The treatment is usually long term. Stick with prescribed diet, medication, and exercise to prevent hyper/hypoglycemic episodes. Keep sugar/sweets with you at all times in case hypoglycemic episode occurs.

Question 21

metropolol

Answer 21

Route: Oral

Indications: Hypertension, angina, prevention of MI and decreased mortality in pt with recent MI, management of stable symptomatic heart failure due to ischemic, hypertensive, or cardiomyopathic origin.

Contraindications: uncompensated heart failure, pulmonary edema, cardiogenic shock, bradycardia, heart block, bad SA node

ADEs: fatigue, weakness, bradycardia, hypotension

Nursing Implications/Teachings: Take meds as directed (don’t skip or double up), abrupt withdrawal may cause arrhythmia, hypertension, or myocardial ischemia. Check pulse daily and BP biweekly. Change positions slowly to minimize orthostatic hypertension.

Question 22

ondansetron

Answer 22

Route: oral

Indication: prevention of nausea and vomiting associated with highly or moderate emetogenic chemo; prevents nausea and vomiting associated with radiation; prevention and treatment of postoperative nausea and vomiting.

Contraindications: hypersensitivity; allergy to aspartame; congenital long QT syndrome; concurrent use of apomorphine

ADEs: headache, dizziness, drowsiness, torsade de pointes, constipation/diarrhea

Nursing Considerations/Teachings: Take meds as directed. Notify HCP if symptoms of irregular heart beat, serotonin syndrome, or involuntary movement of eyes, face, or limbs occur.

Question 23

oxycodone

Answer 23

Route: Oral

Indications: moderate to severe pain; pain severe enough to require daily, round the clock long term treatment for which alternatives are inadequate

Contraindications: hypersensitivity; significant respiratory depression; paralytic ileus; acute or severe asthma

ADEs: confusion, sedation, dizziness, orthostatic hypotension, constipation, respiratory depression; psychological/physical dependence, tolerance.

Nursing Implications/Teachings: OD on opioids can cause death - make sure to clarify all orders and have a 2nd practitioner check order and dose calculations. Do not confuse with long acting oxycontin. Explain therapeutic value of med and to only take as needed, potential for abuse. Should be discontinued gradually. May be administered with food or milk to minimize GI irritation. May cause drowsiness. Avoid alcohol or CNS depressants.

Question 24

potassium

Answer 24

Route: oral

Indications: treatment/prevention of potassium depletion arrhythmias due to digoxin toxicity.

Contraindications: hyperkalemia, severe renal impairment, untreated Addison’s

ADEs: confusion, restlessness, weakness, arrhythmias, ECG changes, paralysis

Nursing Implications/Teachings: Advise sources of dietary potassium; instruct to report dark, tarry, bloody stools, weakness, unusal fatgiue, tingling of extremities to HCP. F/u is important.

Question 25

prednisone

Answer 25

Route: oral

Indications: inflammation, immunosuppression, endocrine disorder; used systemically and locally in chronic diseases (inflammatory, allergic, neoplastic, and autoimmune). Suitable for alternate day dosing in management of chronic illness. Suppresses inflammation andnormal immune resonse

Contradinciations: active untreated infections, some contain alcohol, lactation

ADEs: depressions, headache, hypertension, nausea, vomiting, acne, cushing appearance

Nursing Considerations/Teachings: assess involved systems before and periodically during therapy; assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, lethargy) before and periodically during therapy. Monitor I&Os. Instruct patient to take as directed and to not stop abruptly - might cause adrenal insufficiency. Glucocorticoids cause immunosppression and may mask symptoms of infection.

Question 26

bacitracin

Answer 26

Route: topical

Indications: localized infections due to susceptible organisms

Contraindications: hypersensitivity, renal impairment

ADEs: nausea, vomiting, rash

Nursing considerations/Teachings: assess lesions prior to and periodically during therapy. Take drug exactly as directed. Caution to notify health care professional if fever and diarrhea occur, expecially if it contains blood, pus, mucus.

Question 27

fentanyl patch

Answer 27

Route: topical

Indications: moderate to severe chronic pain

Contraindications: hypersensitivity, acute, mlid, intermittent, or post-op pain; respiratory depression; acute or severe bronchial asthma.

ADEs: Nausea, vomiting, constipation, sedation, respiratory depression, bradycardia, hypotension.

Nursing Implications/Teachings: Assess type/location/intensity of pain prior to and 1 hour after administration. Assess BP, pulse, and respirations before and periodically during administration. Prolonged use may lead to physical and psychological dependence and tolerance. Instruct patient on how and when to ask for pain meds; pt call for assistance when ambulating; change positions slowly to avoid orthostatic hypotension. Avoid concurrent use of alcohol or other CNS depressants.

Question 28

hydrocortisone cream

Answer 28

Route: topical

Indications: inflammation & pruritius from allergic/immunologic skin problems.

Contraindications: hypersensitivity, untreated bacterial or viral infections.

ADEs: dryness, irritation, burning, edema

Nursing Considerations/Teachings: assess affected skin before and daily during therapy noting degree of inflammation and pruritis. Take drug as directed and demonstrate correct technique of administration. Corticosteroids may cause immunosuppression that mask symptoms of infection

Question 29

lidocaine patch

Answer 29

Route: topical

Indications: pain due to post-op neuralgia

Contraindications: hypersensitivity, third degree heart block

ADEs: Stinging, irritation, confusion, drowsiness, seizure, cardiac arrest

Nursing Considerations/Teachigns: monitor for pain intensity periodically during therapy. Explain purpose of the lidocaine to the patient and advise that may cause drowsiness and dizziness. Call for assistance during ambulation. Avoid contact with water –> may not stick if it gets wet. If irritation or burning, remove patch until irritation subsides

Question 30

nitroglycerine patch

Answer 30

Route: topical

Indications: long-term prophylactic management of angina pectoris.

Contraindications: hypersensitivity, increased intracranial pressure, severe anemia.

ADEs: nausea, vomiting, dizziness, headache, hypotension, tachycardia, contact dermatitis.

Nursing considerations/Teachings: assess location, duration, intensity, & precipitating factors of anginal pain. Monitor BP & pulse before and after administering. Instruct pt to take as directed even if feeling better. Caution pt on changing positions slowly to minimize orthostatic hypotension. Avoid use of alcohol. Headache common side effect. Notify HCP if dry mouth or blurred vision occurs.

Question 31

enoxaparin

Answer 31

Route: subcutaneous

Indications: prevention of venous thromboembolism, DVT, and pulmonary embolism

Contraindications: hypersensitivity

ADEs: nausea, vomiting, dizziness, headache, bleeding, thrombocytopenia

Nursing Implications/Teachings: assess for signs of bleeding and hemorrhage (bleeding gums, nosebleed, tarry stools, fall in hematocrip or BP). Assess pt for evidence of additional or increased thrombosis. Observe injection site for hematomas or inflammation. Instruct patient on correct technique for self injection, care, and disposal of equipment. Advise pt to report symptoms of unusual bleeding, dizziness, itching, rash, fever, difficulty breathing. Do not take with aspirin, naproxen, or ibuprofen without discussing with HCP.

Question 32

heparin

Answer 32

Route: subcutaneous

Indications: thromboembolic disorders (venous thromboembolism, pulmonary emboli, afib)

Contraindications: hypersensitivity, uncontrolled bleeding, history of heparin induced thrombocytopneia, open wounds.

ADEs: fever, rash, bleeding, heparin-induced thrombocytopenia

Nursing Implications/Teachings: assess for signs of bleeding and hemorrhage. Assess platelet count. Instruct patient in correct technique for self-injection, care, and disposal of equipment. Advise pt to report any sumptoms of unusal bleeding or bruising, dizziness, rash, fever, difficulty breathing. Advise not to take aspirin, naproxen, or ibuprofen without discussing with HCP.

Question 33

insulin - (short & long acting)

Answer 33

Route: subcutaneous

Indications: diabetes

Contraindications: hypersensitivity, hypoglycemia

ADEs: swelling, pruritius (itching), hypoglycemia, hypersensitivity reactions.

Nursing Implications/Teachings: Assess for symptoms of hypoglycemia (anxiety, restlessness, tingling, chills, pale skin, drowsiness, excessive hunger, irritability) and hyperglycemia ( confusion, drowsiness, flushed dry skin, fruit like breath odor, rapid breathing, unusal thirst) throughout therapy. Monitory body weight periodically. Instruct patient on proper technique for administration - type of insulin, equipment, storage, discarding syringes. Discuss importance of not changing brands of insulin or syringes, selection and rotation of injections sites. Explain that this is not to cure diabetes, therapy is long term. Instruct patient on signs and symptoms of hypo and hyperglycemia and to carr a source of sugar.

Question 34

cyanocobalamin

Answer 34

Route: intramuscular

Indications: vitamin B12 deficiency, pernicious anemia

Contraindications: hypersensitivity

ADEs: diarrhea, itching, hypokalemia

Nursing considerations/Teachings: assess patient for signs of vitamin B12 deficiency before and periodically during therapy (pallor, neuroapthy, psychosis, red inflamed tongue). Monitor serum potassium levels. Encourage patients to have a diet high in B12 (meat, seafood, eggs) and that with pernivious anemia, vitamin B12 replacement is a lifelong need.

Question 35

latanoprost opthalmic solution

Answer 35

Route: eye drop

Indications: increased intraocular pressure with hypertension or open angle glaucoma.

Contraindications: hypersensitivity, intraocular inflammation.

ADEs: dry eye, itching, lid discomfort, blurred vision, eye pain

Nursing considerations/Teachings: risk of iris color changing in treated eye and darkening of the eyelid. Remove contacts before instilling solution and wait 15 mins before inserting. Wash hands before using eyedrops and do not touch tip of the dropper or place it directly into eyes.

Question 36

timolol

Answer 36

Route: eye drop

Indications: treatment of open-angle glaucoma and ocular hypertension.

Contraindications: serious heart conditions, COPD, myasthenia gravis, skeletal musculo disorder, asthma.

ADEs: eye irritation, temporary blurred vision, itching, stinging, eye pain, muscle weakness, bradycardia, arrhythmias

Nursing considerations/Teachings: do not use while wearing contacts - wait 15 mins before putting back in. Wash hands before and do not touch tip of eye dropper or place directly in eyes. Do not stop using medicine suddenly, taper off within 2 weeks.

Question 37

albuterol

Answer 37

Route: inhaler

Indications: treatment or prevention of bronchospasms in asthma or COPD. Prevention of exercise induced bronchospams

Contraindications: hypersensitivity

ADEs: nervousness, restlessness, tremor, paradoxical bronchosapsm, chest pain, palpitations.

Nursing considerations/Teachings: Observe for paraxodical bronchospasm, withhold and notify HCP immediately if occurs. Assess lung sounds, pulse, BP before and during peak of medication. Monitor pulmonary function tests before initial therapy and during. Teach pt to take as directed and not to exceed recomended ammount. Contact HCP if shortness of breath is not relived by the medication. Inform pt that it may cause unusal or bad taste. Avoid smoking and other respiratory irritants.

Question 38

fluticasone propionate

Answer 38

Route: inhaler

Indications: maintenance and prophylactic treatment of asthma.

Contraindications: hypersensitivity, acute asthma attacks.

ADEs: headache, dizziness, horaseness, diarrhea, bronchospasm, adrenal suppression, bone pain

Nursing considerations/Teachings: monitor respiratory status and lung sounds, assess pulmonary function tests periodically. Assess patients changing from systemic corticosteroids to inhalation corticosteroids for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia) during initial therapy and periods of stress. Teachin pt to take as directed, call HCP if it doesn’t improve asthma episodes/ADEs. Avoid smoking and respiratory irritants. Use cautiously with pt with untreated infections and suppressed immune functions.

Question 39

ipratropium

Answer 39

Route: inhaler

Indications: maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema.

Contraindications: hypersensitivity; avoid during acute bronchospasm

ADEs: nausea, cough, dry mouth, headache, dizziness, hypotension

Nursing implacations/Teachings:
assess respiratory status before admin meds and during peak of meds. If paradoxical bronchospams occurs, withold medication and notify health care professional immediately. Instruct proper use of inhaler, rinsing mouth after use, and not to exceed 12 doses in 24 hrs.

Question 40

ceftriaxone

Answer 40

Route: intravenous

Indications: treatment of bacterial infections, perioperative prophylaxis.

Contraindications: hypersensitivity to cephalosporins or penicillins.

ADEs: diarrhea, rash, seizures, c.diff assoc diarrhea, anaphylaxis.

Nursing Implications/Teachings: assess pt for infection (vital signs; appearance of wound, sputum, urine, and stool, WBC count) at begining of and throughout therapy. Obtain specimen for culture and sensitivity before therapy. Monitor bowel function for signs of CDAD. Observe for signs and symptoms of anaphylaxis. Instruct pt to take meds as directed and finish therapy. Notify HCP if fever, diarrhea develop (particuarly w/ blood, mucus, or pus). Advise pt to report rash and signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul smelling stools, and allergy)

Question 41

ciprofloxacin

Answer 41

Route: intravenous

Indications: treatment of bacterial infections

Contraindications: hypersensitivity, history of myasthenia gravis

ADEs: nausea, diarrhea, vomiting, seizures, C.diff assoc diarrhea

Nursing Implications/Teachings: assess patient for infection (vital signs, appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Obtain specimen for culture & sensitivity before therapy. Monitor bowel function for signs of CDAD. Observe for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing).

Pt: take meds as directed, finish the entire course. Notify HCP if fever and diarrhea develop (esp with blood, mucus, or pus). Advise pt to report rash and signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul smelling stools) and allergy.

Question 42

doxycycline

Answer 42

Route: intravenous

Indications: treatment of bacterial infections, treatment of acne, prevents malaria.

Contracindications: hypersensitivity

ADEs: nausea, vomiting, dirarrhea, photosensitivity, c.diff assoc diarrhea

Nursing implications: assess pt for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Obtain specimen for culture and sensitivity before therapy. Monitor bowel function for signs of CDAD. Observe for signs and symptoms of anaphylaxis (rash, pruritius, laryngeal edema, wheezing. Advise pt to avoid taking antacids, calcium, magnesium containing meds, sodium bicarbonate, and iron supplements within 1-3 hrs of oral doxycycline.

Pt: take meds as directed/finish full course. NOtify HCP if fever and diarrhea develop (esp w/ blood, mucus, or pus). Advise pt to report rash and signs of superinfection (black furry overgrowth on tongue., vaginal itching or discharge, loose or foul smelling stools) and allergy. Caution pt to use sunscreen and protective clothing to prevent photosensitivity reactions. May cause discoloration of teeth.

Question 43

piperacillin/tazobactam

Answer 43

Route: intravenous

Function: extended spectrum penicillin

Indications: appendicitis and peritonitis; skin and skin structure infections; gynecologic infections.

Contraindications: hypersensitivity to penicillins, beta lactams, cephalosporins, or tazobactam.

ADEs: Nausea, vomiting, diarrhea, rash, seizures, c diff assoc diarrhea, anaphylaxis.

Nursing Implications: asess pt for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Obtain speciment for culture & sensitivity before therapy. Monitor bowel function for CDAD. Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).

Pt: Take meds as directed/ full course. Notify HCP if fever and diarrhea develop (esp if diarrhea contains blood, mucus, or pus). Advise pt to report rash and signs of superinfection (black furry overgrowth on tongue, vaginal itching, or discharge, loose or foul smelling stools) and allergy.

Question 44

pantoprazole

Answer 44

Route: intravenous

Indications: erosive esophagitis associated with GERD.

Contraindications: hypersensitivity

ADEs: diarrhea, headache, flatulence

Nursing considerations: assess routinely for epigastric or abdominal pain.

Pt: Take meds as directed/full course. Report onset of black, tarry stools; diarrhea; or abdominal pain to HCP. Notify HCP if pregnancy is planned or suspected, or if nursing.

Question 45

vancomycin

Answer 45

Route: intravenous

Indications: treatment of potentially life threatening infections when less toxic anti-infectives are contraindicated; particularly useful in staphylococcal infections.

Contraindications: Hypersensitivity

ADEs: Red Man Syndrome (rash above torso, flushing, hypertensive), nausea, vomiting, phlebitis, nephrotoxicity.

Nursing Implications: assess pt for infection (vital signs; appearance of wound, sputum, urine and stool; WBC) at beginnning and throughout therapy. Obtain specimen for culture & sensitivity before therapy. Assess pt for signs of superinfection (black, furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stool). Observe for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Monitor intake and output ratios and daily weight. Monitor IV site closely; rotate IV sites.

Pt: take meds as directed/full course. Report signs of hypersensitivity, tinnitus, vertigo, or hearing loss. Notify HCP if pregnancy is planned or suspected or chest feeding.