Pharm Final Flashcards
1
Q
Client and wife are taking the same drug but are experiencing different side effects, they want to know if they are doing something wrong?
A
No, differences such as sex can result in different side effects.
2
Q
Client wants to know how long before topical medication will start working?
A
It might take a few days to see noticeable improvement in rash.
3
Q
When preparing clients antihypertensive medication atenolol (Tenormin) ordered 50 mg daily, nurse notices HCP has ordered 100 mg daily, nurse should?
A
Read HCP most recent note indicating a reason for increasing the medication and of not found contact HCP.
4
Q
What is accurate regarding the Institute for Safe Medication Practices (ISMP)?
A
It publishes a monthly consumer newsletter regarding medication errors.
5
Q
Nurse administers vaccine and understands that?
A
Vaccines are naturally produced in animal cells or microorganisms.
6
Q
Best definition for the term “adverse reaction?”
A
A harmful or undesirable response to a medication.
7
Q
Elderly client presents with low HR and BP, client indicates HCP prescribed 3 new meds and are now on 10 total meds, what is most accurate?
A
Client is experiencing adverse reactions due to the 3 new medications added.
8
Q
Nurse provides med education to client taking Schedule IV drug learning has occurred when client states what?
A
The Dr has given me a prescription with 4 refills. I need to come back for a checkup in 4 months.
9
Q
Nursing instructor teaches student nurses about pharmacological classification of drugs, learning has occurred when students say?
A
A calcium channel blocker blocks calcium channels in the heart.
10
Q
Nurse getting ready to administer new medication to client when they state they think they had the medication once before and had a reaction, what does nurse do?
A
Ask client what type of reaction and contact HCP to check history of allergies.
11
Q
Nurse preparing clients med, what is NOT legal responsibility of nurse?
A
Identify clients diagnosis, determining the dosage.
12
Q
What is most important to remember about Food, Drug, and Cosmetic Act?
A
It prevented sale of drugs that had not been thoroughly tested before marketing.
13
Q
Physician ordered Schedule II drug for client nurse determines learning has occurred when client states what?
A
I need to see my doctor before my prescription runs out so I can get a refill.
14
Q
During admission client tells nurse that he snorts cocaine, what is the best assessment question?
A
How often do you snort cocaine and how many lines each time?
15
Q
Nurse checks MAR and observes client is on 6 meds. When determining side effects, nurse should be concerned if?
A
Two of three six medications have bradycardia as a side effect.
16
Q
HCP prescribes lisinopril (Zestril) 10 mg PO every day, why type of order is this?
A
Routine order
17
Q
Nurse suspects client is not taking antihypertensive med because BP still elevated, what therapeutic question can be asked that will assess for noncompliance?
A
Taking medication is difficult for many people. What are some of your concerns about the medication?
18
Q
Elderly client has GI bleeding, client says they took aspirin. Best education?
A
A plan to teach the advantages and disadvantages of aspirin including taking enteric coated.
19
Q
Nursing student assigned to new client and checks MAR observing client is on 4 medications, when determining interactions between these meds what is safety concern?
A
Two of the meds cause drowsiness.
20
Q
Client receives drug that’s excreted in bile. What will the best nursing assessment of the effect of this drug on the client?
A
It will have a prolonged action.
21
Q
Client is malnourished and has low serum albumin. Physician ordered aspirin, a highly protein bound drug. What effect will this have on client?
A
Client will be at risk for toxicity, due to there being no protein for the drug to bind to.
22
Q
Client admitted to hospital in chronic renal failure and is on several medications. Assessment?
A
The client may have drug toxicity from all of the drugs.
23
Q
Client prescribed phenobarbital sodium (Luminal) for seizure disorder, this drug has long half life of 4 days. Based off the half life it will most likely be prescribed?
A
Once a day.
24
Q
Prior to administering medications, the student nurse reviews the therapeutic index of their medications on their list. What best describes narrow therapeutic index?
A
Clients will need to have serum blood levels monitored due to low safety margin.
25
Contraindications
Indicate why a medication should NOT be given.
26
Toxicity
A serious adverse reaction usually caused by excessive dosing.
27
Mechanism of action
How the medication produces its desired therapeutic effect.
28
Therapeutic effect
Primary action for which the medication is prescribed.
29
Client has brain infection. Physician initially prescribed water soluble antibiotic. Another physician changed the order to lipid soluble antibiotic. Client is confused. What nursing education plan best instructs the client? Lipid soluble medications are...
More effective in treating their illness.
30
Med dosages may need to be decreased for which reasons?
Liver failure and concurrent use of med by same pathway.
31
Client wants to know why newer drug is more effective than older drug?
Research into receptors helps "fine tune" drugs to be more effective. Newer drugs are altered to affect your cells receptors in a different way.
32
Client taking med with narrow therapeutic range and long half life and wants to know why his blood is drawn so often. Response?
To be sure you have the correct amount of med in your system.
33
Client taking many different medications and wants to know how they get to all the right places. Nurse says hat depends on?
Blood flow to tissues, protein in body, whether it is fat based or water based.
34
Client received loading dose followed by lower dose and wants to know why?
You had a larger dose initially so that the medication would work more quickly.
35
Nurse proving med education to hypertensive client. Focus is on enhancing absorption of medications. Statement that proves learning has occurred?
I need to be careful about taking the medication with certain foods.
36
Anticholinergic drugs block effects of?
Acetylcholine
37
Best description of drugs therapeutic effect?
The desirable response based on its intended purpose.
38
When counseling a client who is prescribed hepatotoxic med, nurse should include what safety education?
Avoid alcohol.
39
Protein binding of drugs refers to the...
Complex formed with the med and plasma proteins.
40
Increase med dosages for what reasons?
Increased med metabolizing enzymes, increased renal excretion, peripheral vascular disease depending on liver/renal function.
41
Client receiving anti seizure med with half life of 2-3 hours. You would expect dosage to be given?
Every 6 hours.
42
What is true regarding distribution?
Adequate blood flow is necessary for drug distribution.
43
Client has low serum albumin levels. Physician orders glipizide a highly protein bound drug to lower blood sugar for this diabetic client. What effect will this have?
Client will be at risk for hypoglycemia.
44
The four major components of pharmacokinetics? How drugs...
Are converted to a form that is easily removed form body, are transported, removed, move from site of administration to circulation.
45
When drugs bind with receptors what response occurs?
Pharmacologic effects of agonism or antagonism occur.
46
Client develops decreased renal function and requires an alteration in antibiotic dosage. What would physician base this change on?
Creatinine and BUN.
47
Client receiving narrow therapeutic level drug this requires order from physician for?
Peak and trough levels.
48
Client stopped taking med with long half life and is experiencing less drowsiness and no seizures. Best explanation?
Drug's previous doses have not been completely eliminated from the body but are partially eliminated making her less drowsy.
49
What age related factor could effect pharmacokinetics of drug administered to 87 yr old?
Reduced ability of liver to metabolize.
50
Nurse administers atropine to client experiencing shortness of breath and fatigue with 2nd degree heart block. Response?
Increase HR. Due to atropine blocking parasympathetic action of acetylcholine and inducing symptoms of fight or flight.
51
Client diagnosed with Parkinson's. Client wants to know how this medication will help?
This med will help you eat and walk. The goal is to increase ability of client to perform ADLs.
52
Nurse completed med education about neostigmine (Prostigmin) an indirect cholinergic drug, for client with myasthenia gravis. Nurse determine learning has occurred with what statement?
It is really important to take my medication on time before eating.
53
Client is quadriplegic and receives oxybutynin (Ditropan) an anti cholinergic drug to increase bladder capacity. What is important assessment by nurse?
Is client constipated.
54
Client takes levodopa (Larodopa). Nurse understands effective learning has occurred when?
Client states they must increase fiber in diet. Constipation is side effect from this medication.
55
Alzheimer's clients wife education statement?
The medication may help symptoms for a little while.
56
Physician orders bethanechol (Urecholine) a cholinergic drug for client with urinary retention. Client also has enlarged prostate. Nursing action?
With hold medication and call HCP.
57
Nurse preparing to administer meds to a group of clients. One med is benztropine (Cogentin) an anti cholinergic. This drug is contraindicated in which client?
Client with tachycardia because anticholinergic drugs increase the HR.
58
Pramipexole (Mirapex) an antiparkinsons med can cause what adverse reaction?
Hallucinations.
59
Expected pharmacological action of benztropine (Cogentin)?
Blocks acetylcholine at muscarinic receptors, which assists in maintaining balance between dopamine and acetylcholine in brain.
60
You made med error and reported it. Purpose of this?
Prevent future med errors.
61
Nurse planning teaching for client and family, which information should be include for Alzheimer's client?
Symptoms are progressive, meds may decrease symptoms but there is no cure, meds may be taken with food, dry mouth is expected.
62
Nurse discussing donepezil hydrochloride (Aricept) with family of Alzheimer's client. Explain what side effects?
Muscle cramps, dizziness, insomnia, headache.
63
To increase absorption of levodopa/carbodopa client should avoid?
Eating cheeseburgers made form lean ground sirloin.
64
What neurotransmitter is deficient in clients with Parkinson's?
Dopamine.
65
Adrenergic agonists stimulate SNS and cause?
Dilated pupils (mydriasis)
66
Bethanechol (Urecholine) drug class?
Muscarinic agonist.
67
Neostigmine (Prostigmin) drug class?
Cholinesterase inhibitor.
68
What meds could reverse the mechanism of action for bethanechol (Urecholine)?
Oxybutynin (Ditropan) a muscarinic antagonist.
69
Client taking pramipexole (Mirapex) for early Parkinson's. What is an important safety measure?
Take a taxi to your office.
70
Important safely administration for prazosin (Minipress) an antihypertensive?
Watch for first dose syncope secondary to orthostatic hypotension.
71
Initial treatment for Alzheimer's client?
Donepezil hydrochloride (Aricept)
72
Nurse caring for client prescribed oxybutynin (Ditropan). Client will have...
Fewer episodes of nocturia.
73
Nurse checking clients BP for administering adrenergic antagonist med. Which systolic is unsafe for administering this med?
90 mmHg
74
Anticholinergic drugs?
Block acetylcholine.
75
Older adults taking bethanechol (Urecholine) need to be assessed for what side effect?
Dizziness
76
Anticholinergic drugs are contraindicated in?
Bowel obstruction clients.
77
Nurse monitoring client for adverse effects associated with adrenergic antagonists. Which effect is related to first dose pass phenomenon?
Syncope.
78
67 yr old male with mild HF and moderate isolated systolic HTN. His HF is manifested by 1+ pitting edema, shortness of breath, mild inspiratory rales/rhonchi bilaterally. He is prescribed furosemide and lisinopril daily. Client education?
It is ok to take these together because it will balance out the K levels. Weigh daily and report any 2+ lbs gain. Move carefully due to orthostatic hypotension. Report muscle weakness. Follow high K low sodium diet.
79
Hospitalized client taking spironolactone (Aldactone). HCP orders lisinopril (Prinivil). Nurse assessment?
Hyperkalemia
80
Client takin STATIN drug. What assembly data needs to be reported?
Urine output of less than 30ml/h. Rhabdomyolysis is side effect of this drug that causes contents in muscle cells to leak into circulation which can cause renal failure.
81
Client with primary HTN and CAD recently has had new diagnosis of type 2 diabetes and was placed on metoprolol (Toprol XL) daily to decrease workload of the heart. Nursing education?
This is a selective beta blocker. Clients need to check BP/ pulse daily and report of less than 60 BPM, or less than 90 mmHg systolic. Educate to change positions slowly due to orthostatic hypotension.
82
Client taking hydrochlorothiazide (HydroDIURIL), he tells nurse he is urinating a lot and questions how drug is affecting his BP. Response?
This drug decreases the fluid in your bloodstream and lowers your BP.
83
Client receiving spironolactone (Aldactone) potassium sparing drug. What foods are contraindicated with this drug?
Foods high in potassium such as bananas and orange juice.
84
Client taking prazosin (Minipress) for HTN. How does med work?
It works by making blood vessels expand. This drug is selective for blocking alpha 1 receptors in vascular smooth muscle, which results in dilation of arteries and veins.
85
Client taking STATIN drug. What data would need to be reported?
Client states that their calf hurts and they are having a hard time walking to bathroom. This is an indication of possible rhabdomyolysis.
86
Client tells nurse his doctor wants him to take a med for his high cholesterol. What drugs are best?
The STATIN drugs inhibit the making of cholesterol and are considered he best choice. Fibric acid drugs will decrease triglycerides, but your LDL will still be high.
87
Why laboratory test would be high for client taking THIAZIDE diuretic?
Sodium and potassium. Client could develop Hypokalemia.
88
Hydrochlorothiazide (HydroDIURIL) should be taken when?
In the morning. It will get rid of any extra fluid in the body and this lowers blood pressure.
89
Nurse interventions when giving nitroprusside (Nitropress) for a client with acute hypertensive crisis?
Thiocyanate level, stop med if BP gets too low because within 4-6 mins BP will increase, monitor HR with telemetry, continuous BP monitoring.
90
Client taking furosemide for HF and HCP orders you to give 80 mg IV push over 1 min. Potential side effect?
Hearing loss.
91
Client on loop diuretic and nurse suspects they are experiencing side effects. Why?
Client serum potassium is 2.8 (should be between 3.5-5.0) and BP of 85/48.
92
Ezetimibe (Zetia) MC or SC?
Cholesterol absorption inhibitor.
93
Nurse provides teaching to client taking lovastatin (Mevacor). Teaching statement?
Take this med with evening meal.
94
Atorvastatin (Lipitor) is beneficial for lowering serum cholesterol levels but it is also?
Beneficial for preventing formation of thrombi by decreasing the inflammatory process of the arteries.
95
Concerned when physician combines fosinopril (Monopril) and spironolactone (Aldactone)?
Ask for a potassium level.
96
Identify the major difference between losartan (Cozaar) an ARB and captopril (Capoten) an ACE inhibitor?
ARBs do not have a cough as a side effect.
97
Gemfibrozil (Lopid) MC or SC?
Fibrate
98
Client with end stage COPD and chronic HF. HCP ordered spironolactone (Aldactone) and a loop diuretic twice a day. Why are these drugs combined?
By combining a drug that gets rid of K and one that holds onto K this will normalize K levels.
99
Client receiving alpha adrenergic blocker for HTN and wants to know how it works?
It works by making your blood vessels expand.
100
Priority nursing intervention for client hat just stared taking cardio selective beta adrenergic blocker esmolol (Brevibloc)?
Assess the clients BP.
101
Expected action for lisinopril (Prinivil)?
Block production of angiotensin II, excrete sodium and water, retention of K, reduction in pathological changes in blood vessels and heart, arteriole vasodilation.
102
Which drug lowers BP by reducing HR?
Metoprolol succinate (Toprol XL)
103
Client taking STATIN. Assessment data to be reported?
It is hard for me to hold brush to comb hair, my hands keep cramping up. This is a sign of rhabdomyolysis.
104
Nurse administering mannitol (Osmitrol) to client who has increased intracranial pressure. What finding would cause nurse to stop med and notify physician?
Shortness of breath and edema.
105
The difference in action between cardio selective calcium channel blocker nifedipine (Adalat) and non selective calcium channel blocker verapamil (Calan) for treating HTN?
Non selective calcium channel blockers block channels in SA and AV node potentially causing dysrhythmias, while selective block calcium channels in arterioles causing vasodilation.
106
Metoprolol (Lopressor) an cardio selective beta adrenergic blocker side effects?
AV block, orthostatic hypotension, decreased cardiac output.
107
What med will decrease the antihypertensive effects of lisinopril (Prinivil)?
NSAIDS
108
Action for THIAZIDE diuretic?
Blocks reabsorption of NaCl and prevents the reabsorption of water at this site. Blocks reabsorption of NaCl and to prevent reabsorption of water. Promotes diuresis when renal function not impaired.
109
Identify pharmacological action for HMG COA Reductase inhibitors (STATINS)?
Decrease in plaque site inflammation. Decrease in manufacture of LDL. Increase in manufacture of HDL. Promotion of vasodilation.
110
Client taking nitroglycerin (Nitrostat) for relief of occasional stable angina. The nurse would be most concerned about what statement made by the client?
"I'm getting married tomorrow, I hope my erectile dysfunction isn't a problem." This client is likely to use erectile dysfunction medication which when used together can cause life threatening hypotension.
111
What lab test would cause nurse to contact HCP?
aPPT of 97 seconds. Normal aPPT is 30-40 seconds. The therapeutic level with heparin is 60-80 seconds.
112
A clients PICC line is occluded with thrombus, what agent will lyse this clot?
Ateplase
113
The HCP ordered amiodarone (Cordarone) for male client being discharged after tx of reoccurring VFib that is unresponsive to other agents. HCP prescribes 1000mg PO daily. Reason for high dose?
Large dose is required since you had a life threatening dysrhythmia.
114
Client says his neighbor thinks antidysrythmic drugs can cause irregular heart beat. Why?
Your medication blocks the flow of the electrolytes in your heart and this can cause irregular beats.
115
Client taking procainamide (Pronestyl) for dysrhythmia. Best client compliance?
Client will continue to take med as directed even if he is feeling well.
116
In educating client on warfarin?
It is contraindicated in pregnancy because it will cross the placenta.
117
Clopidogrel is indicated for?
Reduction of myocardial infarction, stroke, and vascular deaths in clients with atherosclerosis.
118
Aspirin suppresses blood clotting by?
Decreasing platelet aggregation.
119
MC or SC of procainamide (Procan)?
Antidysrythmic
120
Client started clopidogrel after TIA. Therapeutic action?
Reduce risk of stroke from blood clot.
121
Client education for enoxaparin and warfarin?
Report pink, red, brown urine and bloody gums to HCP. Properly dispose of enoxaparin syringes. Do not take OTC drugs without checking with HCP. Have lab work done at least weekly and prn for a PT/INR.
122
MC or SC for clopidogrel (Plavix)?
Anti platelet.
123
Identify 3 hemostatics for clients receiving anticoagulant or thrombolytic treatment?
Vitamin K (Mephyton), aminocaproic acid (Amicar), and protamine sulfate.
124
Client admitted to ED with VTach is treated with amiodarone IV. When assessed 3 hours later, complaining of light headedness and dizziness. First assess?
BP and pulse.
125
Meds for ED are contraindicated in clients taking nitrates for angina. What is the concern for taking these meds together?
Decrease in BP that may result in severe hypotension.
126
Client prescribed IV med for tx or DVT. When will it work?
Almost immediately.
127
Client receiving IV alteplase following ischemic stroke. Nurse assesses for what side effect?
Bruising and epistaxis.
128
Contraindications for administering aspirin?
Child with viral infection. Client with bleeding disorder. Client with PUD.
129
Client taking heparin sodium and the aPPT level returns above the recommended therapeutic range. Besides notifying HCP what is priority regarding medication half life?
Immediately shut off IV pump.
130
Nurse monitoring for therapeutic effect after giving procainamide IV. What essential parameter would nurse monitor?
BP and pulse.
131
Common adverse effects for which the RN monitors for when giving antidysrythmics?
Weakness, hypotension, dizziness.
132
Clint taking heparin sodium via continuous IV. What lab value is appropriate to monitor in order to evaluate the effectiveness?
Activated partial thromboplastin time (aPPT).
133
Client with chronic alcoholism asks nurse why he is on folic acid. Response?
You have been drinking instead of eating and alcohol interferes with folate metabolism in your liver.
134
Nurse teaching client taking digoxin (Lanoxin) for HF. Which indicates toxicity and should be reported to HCP?
Diplopia, anorexia, fatigue, bradycardia.
135
What adverse reactions occur with epoetin alfa (Epogen) that the nurse should monitor for?
Elevated BP and hemoglobin.
136
What should nurse do when preparing to administer filgrastim (Neupogen) for the first time to a client that underwent bone marrow transplant?
Discard the vial after removing 1 dose and premedicate with acetaminophen or opioid to prevent bone pain.
137
Clint on chemo is prescribed oprelvekin (Neumega) what statement validates that teaching was effective?
"This med will increase my platelet count."
138
Dopamine is?
A sypathomimetic which imitates fight or flight response. Must be given IV and requires close monitoring.
139
Nurse teaching about foods high in potassium?
Spinach, orange juice, raisins, sweet potatoes, milk.
140
Client with pernicious anemia is prescribed cyanocobalamin injections. Educate?
Liquid preparations need to be sipped through a straw since they can stain teeth.
141
Client takes epoetin alpha (Epogen) SQ and wants to know what is in the injection?
This will help your body make more RBCs, erythropoietin also helps your body make more hemoglobin, your kidney will make more erythropoietin if it doesn't get enough oxygen.
142
Client receiving metropolol (Lopressor), furosemide (Lasix), lisinopril (Prinivil) for HF. What indicates that these are NOT effective?
Jugular venous distension.
143
Mechanism of action for sargramostim (Leukine)?
Acts on bone marrow and increases production of WBCs after failed bone marrow transplant.
144
Leukopoitic growth factors stimulate?
Neutrophils
145
What should nurse implement when preparing to administer filgrastim (Neupogen)?
Premedicate 45 minutes prior to administration with acetaminophen.
146
The rationale for client taking cyanocobalamin (Vitamin B12) life time replacement therapy?
Gastric bypass surgery.
147
Client on iron therapy hasn't shown much improvement. What prevents absorption?
The client taking an antacid due to stomach being upset.
148
Desired effects of digoxin?
Decreased cardiac workload.
149
After 15 minutes of the transfusion client complains of low back pain and headache. Nurse suspects hemolytic transfusion reaction. Nurse does what?
Stops transfusion. Sends blood bag and IV tubing to blood bank for analysis. Obtains a urine sample to check for hemoglobin.
150
Adrenergic agonist dopamine is used to test HF at moderate dosing levels because it causes?
Increased rate of conduction through AV node. Increase myocardial contractility. Increased HR. Renal vessel dilation.
151
Med classes commonly used to treat HF?
Selective beta blockers. ACE inhibitors. Loop diuretics. Angiotensin 2 receptor blockers. Cardiac glycosides.
152
MC or SC of filgrastim (Neupogen)?
Hematopoietic
153
Meds that might be used to treat bone marrow suppression from chemo?
Epoetin alpha, oprelvekin, filgrastim.
154
The following are reasons to administer blood products?
Replace post surgical blood loss. Replace clotting factors. Improve platelet count. Improve tissue perfusion. Volume expansion.
155
The parenteral form of ferrous sulfate?
Iron dextran
156
Client on corticosteroid therapy, nurse will assess for what electrolyte imbalance?
Hypernatremia and hyperglycemia.
157
Client has diabetes and receives vasopressin, what statement indicates med learning has occurred?
This med will help water reabsorption in my kidneys.
158
Insulin apart ordered. When will nurse administer this?
When client is eating.
