Pharm Final Flashcards
Match the following respiratory system related drug classes with their prototype drug: Xanthines Inhaled Steroids Antitussives Sympathomimetics
Xanthines: Theophylline
Inhaled Steroids: Budesonide
Antitussives: Dextromethorphan
Sypmathomimetics: Albuterol
The exchange of carbon dioxide and oxygen that occurs within the body is an essential part of homeostasis. When referring to this gas exchange event the nurse would use the term:
Respiration
When describing gas exchange, the nurse should teach a client that oxygen and carbon dioxide enter and leave the body by what method?
Diffusion
The nurse is caring for a client whose respiratory rate has increased from 21 to 32 breaths/minute. This change in status is ultimately caused by what?
Stimulation by the medulla
The nurse is teaching a class about common upper respiratory infections to parents of preschoolers. The nurse should cite what examples? Select all that apply.
Pharyngitis
Sinusitis
Common Cold
A client presents to the clinic with a dry nonproductive cough. The client is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the provider will prescribe?
Guaifensin
A nurse is caring for a patient who has just undergone an invasive abdominal surgery. The patient reports severe pain at the incision site when coughing and has requested an antitussive. The nurse provides education about using an antitussive in this situation and recognizes that the patient understands the teaching when he states:
“Coughing is important after surgery to help prevent post operative pneumonia.”
A patient with sinus pressure and pain related to seasonal rhinitis would benefit from taking:
Pseudoephedrine
A client calls a nurse help line and states he has been taking an OTC decongestant containing pseudoephedrine. The client states he has been feeling strange since taking the medication and wonders if the medication is causing his symptoms. The nurse knows that adverse reactions related to pseudoephedrine include:
Tachycardia
Nervousness
Insomnia
A nurse is participating in education with parents of a six year old child who was just diagnosed with asthma. The nurse explains that asthma is characterized by what factors?
Bronchospasm
Inflammation
Hyperactive Airways
A client is admitted with an asthma attack caused by an allergic reaction to a medication. The nurse is aware that this severe allergic response is triggered by the immediate release of what?
Histamine
The nurse is developing the teaching portion of a care plan for a client with asthma. What would be an important component for the nurse to emphasize?
chronic inhalation of nonallergic inhaled irritants can trigger an attack
A client has been diagnosed with asthma and prescribed inhaled steroids. What should the nurse teach the client about this treatment?
inhaled corticosteroids should not be used on an emergency basis
An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the client be instructed to do?
Use the inhaler 30 to 60 minutes before exercising
The client is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity?
Avoiding beverages that contain caffeine
The nurse is caring for a 38-year-old client with asthma who has been started on albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects?
The client’s heart rate is 99 beats/minute.
What action does an inhaled beta adrenergic agent (which is a sympathomimetic), like albuterol, have on patients with respiratory conditions such as asthma?
Bronchodilation
Ipratroprium (Atrovent) is an inhaled anticholinergic bronchodilator. What is the mechanism of action for Ipratroprium that treats patients with respiratory conditions such as asthma?
They block the cholinergic effect of bronchial constriction by the vagus nerve
All of the following orders (in the responses below) are received for a patient having an acute asthma attack. Which one will the nurse administer first?
Albuterol (Ventolin) 2.5 mg per nebulizer
Chronic Obstructive Pulmonary Disease (COPD) is associated with all of the following characteristics except:
hyperactivity of airways in response to inhaled irritants
A 70-year-old man is being treated for chronic obstructive pulmonary disease (COPD) with theophylline (Theo-Dur). What will be a priority assessment by the nurse?
Use of Nicotine
A client with pneumonia is receiving supplemental oxygen at 2 L/min via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?
Apnea
A patient with COPD tells the nurse, “at home, I only have to use an Albuterol (Proventil) inhaler. Why did the doctor add an Ipratropium (Atrovent) inhaler while I’m in the hospital?” The appropriate response by the nurse is:
“Atrovent works differently to deflate the bronchi, and the two drugs together are more effective”
A patient with many adverse reactions to drugs is tried on Budesonide for treatment of bronchospasm. For the first three days the patient does not notice any improvement. The nurse should:
encourage the patient to continue the drug for 2-3 weeks
Antihistamines block the release or action of histamine and can be helpful with many respiratory tract conditions. This drug class can be separated into two categories known as:
first generation and second generation
A stepped care management approach to treating hypertension includes weight loss, smoking cessation, decreased use of alcohol, reducing salt in the diet, and increased physical exercise. During a stepped-care management approach, when should the nurse teach about these changes in lifestyle?
steps 1, 2, 3, and 4
The nurse is educating an older client about reasons the medication furosemide (Lasix) was prescribed. Which of the following statements would be appropriate to include in the education?
The Lasix will help you get rid of the extra fluid that your heart failure is causing
The nurse is explaining the normal conduction pathway to a client with a dysrhythmia. The nurse should explain what conduction pathway in the heart?
SA node, AV node, Bundle of His, Purkinje Fibers
The nurse provides teaching about digoxin to a client who will be self-administering the drug at home. The nurse determines further teaching is needed when the client says?
(Looking for a wrong answer)
I’ll take the medication with food so I don’t get nauseous
Nitrates are used for therapy to treat angina because they:
cause blood flow to dilate allowing more blood flow
Which class of anti-arrhythmics acts as myocardial cell depressants by inhibiting sodium ion movement into the myocardial cell
Class 1 - Lidocaine - sodium channel blocker
A client is taking hydrochlorothiazide for newly diagnosed essential hypertension, the nurse understands that this medication may cause or aggravate an imbalance in which electrolyte?
Potassium
A nurse is explaining how the myocardium receives oxygen to a newly graduated nurse who is beginning to work in the constant care unit. The nurse explains that the coronary arteries receive blood when?
During diastole
The nurse is caring for a client with decreased blood flow to the kidneys. The client’s blood pressure has been in the range of 150/100 mm Hg for several days. What is the most likely cause of the client’s hypertension?
Release of renin
The hospital nurse who works with the resuscitation team is responding to a code for an unresponsive client. The advanced cardiac life support protocol has been implemented. The nurse should prepare for administration of what medication?
Amiodorone
What measures are available for patients who have supratherapeutic effect of warfarin (Coumadin)?
administration of vitamin K and sometimes plasma
A client with hypertension has been started on Losartan. After 6 weeks of therapy, it is decided that the Losartan alone is not controlling the client’s hypertension. What does the nurse anticipate will be added to the Losartan regimen for better control of this client’s hypertension?
Hydrochlorothiazide
Antihypertensives can work in a variety of different ways to decrease blood pressure. Which of the following medications acts directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation and drop in BP?
Hydralazine
Describe the path blood takes in the body beginning at the right atrium
right atrium, right ventricle, pulmonary arteries, lungs, pulmonary veins, left atrium, left ventricle, aorta, arteriole, capillaries, venules, veins, vena cava
What is the treatment goal for anti arrhythmias
restore normal heart rhythm and prevent it from getting worse
If we have someone who has the beginning of an arrhythmia what are we worried about?
Developing into v-tach
Class 1 antiarrhythmics, another name for it?
sodium channel blockers
What is the prototype for sodium channel blockers?
Lidocaine
Which class of antiarrhythmics is effected by inhibiting cardiac response to sympathetic nervous system and as a result reduces blood pressure and heart rate?
beta blocker - class 2 antiarrhythmic - propranolol
What antiarrhythmic might be used to treat a life threatening ventricular arrhythmia?
Amiodorone, class 3 antiarrhythmic - potassium channel blockers Or Lidocaine, class 1 antiarrhythmic - sodium channel blocker
What are class 2 antiarrhythmics?
Beta blockers
What is heart failure?
inability for the heart muscle to pump efficient amount of blood
What symptoms do we see with left sided heart failure?
lungs. Fluid backing up into the lungs
Right sided heart failure
blood flow, symptoms are seen peripherally, jugular vein distention will show increased intravascular flow
How can digoxin improve heart failure?
slows heart rate
Making each heart beat more effective
Increases intracellular calcium for muscle contraction, you have increased myocardial strength
What else does digoxin do?
decreases blood volumes, increases blood flow to the kidneys so the RAAS system is inhibited a little bit
Increases cardiac output
Effects the conduction system in the heart, slows it down through the AV node. Increasing contractility and slowing the heart increases blood flow through the heart
What nursing considerations are important for a patient who’s on digoxin therapy?
pulse can’t be below 60 before we give digoxin check apical heart rate for full minute
HMP, EKG since digoxin slows conduction of heart we dont want it to create arrythmias, other medications because so many interact with digoxin, we want to monitor digoxin levels and signs of digitalis toxicity.
Name one of the types of angina
stable - no damage to heart muscle, pain is caused but no damage. The pain is resolved with rest
unstable - doesn’t go away with rest and usually requires medication, atherosclerosis, clot, damage to the lining of the vasculature causing the clots
prinzmetal - variant don’t need to know about this one
How do antianginal agents decrease pain associated with atherosclerosis of the coronary arteries?
vasodilation - decreasing workload of the heart
Increases blood flow which contains oxygen,
The pain comes from lack of oxygen and the workload of the heart is too high
What adverse effects come from nitroglycerin
headache dizziness weakness nausea vomiting hypotension flushing
Go along with the vasodilation and drop in blood pressure
2 types of medications used to promote blood clot formation and clot breakdown - blood homeostasis
aspirin - antiplatelet in salicylate class
Heparin - anticoagulants - clotting cascade
Warfarin - anticoagulants - clotting cascade
What nursing considerations are associated with one on warfarin or Coumadin
INR - international normalized ratio for PT
Prothrombin time
There are tons of things that interfere with warfarin
Vitamin K containing foods
How do the kidneys regulate fluid volume and composition?
concentrating and diluting the urine.
Excretion and reabsorption of key electrolytes
When might diuretic therapy be indicated?
kidney disease and renal disease but we wouldn’t use diuretic therapy for all
Heart failure edema
Hypertension
Edema
The purpose of the cell membrane:
Allows things in and out of the cell Cell survival Cell homeostasis Identification of the cell (Not cell maturation)
Someone taking amoxicillin says she’s feeling much better and doesn’t want to take her medicine anymore, what is the best response from the nurse
Even though you’re feeling better it’s important to take all of your pills until the prescription is done
What is the purpose of a laboratory culture?
To identify the specific organism causing the infection
Client is on an anti-infective for a urinary tract infection, the client asks for refills for it since they get UTIs every few months, what should the nurse say?
No, we don’t want to create resistance
Healthcare nurse is caring for someone on gentamicin for cellulitis, what happens for drug resistance to occur
The microbe produces a chemical that is antagonistic to the drug
Client is discharged home an anti-infective, what statement by the client indicates more education is needed.
(Looking for the wrong answer)
I will stop taking the antibiotic once my symptoms resolve
The nurse is caring for a client who has been taking a broad-spectrum antibiotic agent for several days so the nurse should monitor for what?
Destruction of normal flora
Which client is receiving prophylactic treatment
The client receiving antibiotic before dental work
A gram negative infection is being treated with an aminoglycoside, what assessment is prioritized during treatment?
Urine output to be sure kidney is excreting it
Ototoxicity
Nurse is providing teaching to a client taking tetracycline,
Stay out of the sun as much as possible
The nurse is caring for a client who is receiving IV gentamicin and who reports difficulty hearing this morning. What should the nurse do?
Hold the dose and notify the prescriber immediately
When the nurse cares for a client receiving an antibiotic, what instructions should the nurse provide no matter what medication is prescribed?
Drink plenty of fluids
Take all medications until gone
Report difficulty breathing, severe headache, or changes in urine output
A nursing student is assisting with patient education for a patient who has been prescribed penicillin for a suspected staph infection. Which of the following would describe a patient how penicillin works
Penicillin kills bacteria by interfering with cell wall synthesis
Understanding the characteristics of infectious microorganisms helps in developing and choosing pharmacologic agents to fight the infection. A common infectious agent is made of just DNA and a protein coat. This infectious agent can be identified as a:
Virus
A nurse is caring for an elderly patient becomes concerned about the appropriateness of an antibiotic that was newly prescribed to treat the patients upper respiratory infection. The nurse is aware that the prescribed medication carries a risk of tendinitis and tendon rupture in elderly patients. What medication has been prescribed?
Ciprofloxacin
A patient who has been on antibiotic therapy for several days develops uncomfortable white patches in the mouth that is determined to be a Candida fungal infection. This is an example of:
A superinfection
Antibiotics that are used together to increase their effectiveness and limit the associated adverse effects are said to be
Synergistic
Viral infections have proven difficult to treat because they:
Inject themselves into human cells to survive and reproduce
Severe adverse effects related to antimicrobial therapy includes direct toxicity or damage to a particular organ or organ system, match the following terms relating to direct toxicity to the organ or organ system they affect: Ototoxicity Hepatotoxicity Nephrotoxicity Neurotoxicity
Ototoxicity - ears
Hepatotoxicity - liver
Nephrotoxicity - kidney
Neurotoxicity - nervous tissue
Pregnant patient has just been diagnosed with chlamydia, she’s requested to be put on a tetracycline, what should the nurse say in response?
Tetracycline is contraindicated in pregnancy due to the risk of bone and teeth malformation and discoloration in the fetus
Because of the adverse effects of the aminoglycosides, it is important to teach the patient to restrict fluids and eat 6 small meals daily
(T/F)
False
Purpose of the schwann cells
insulate the axon of the nerve and because they are insulating it action potential along the nerve is much faster so a problem with the myelin sheath results in slower nerve conduction.
Client’s nerve transmission has reached the axon terminal of the synapse what event will take place to transmit the information across the synapse?
Neurotransmitters will be released
Client sustained a closed head injury 4 hours ago and now complains of difficulty breathing, the nurse should suspect damage to what part of the brain?
Medulla, it has the respiratory control
Nurse is caring for a client who is having adverse effects of long term antipsychotic treatment, the client is experiencing tremors, shuffles in walking and difficulty sitting in the bed
Interference with the extrapyramidal system
Reticular activating system is sensory and sleep regulation
Someone is taking a benzodiazepine the nurse evaluates education is effective if they say what
I should not stop taking this drug without talking with my healthcare provider
A client gets to the emergency department in respiratory arrest after overdosing on heroin, is given naloxone, we want to monitor for symptoms of acute narcotic abstinence syndrome what side effects
Tachycardia
Hypertension
Vomiting
Someone is getting hydromorphone, which is an opiate agonist, what should the nurse do before administering
Assess the client’s baseline respiratory rate
A client has been diagnosed with cerebral palsey with muscle spasticity what is the causative factor for their symptoms
Usually related to nerve damage. Its usually a central nervous system problem related to nerve damage
Client has been taking levodopa for parkinsons, what medication is given to reduce the side effects of levodopa?
Carbidopa
A nurse is receiving report of a patient with whom she is not familiar, while reviewing her chart she sees the patient is on phenytoin or dilantin, so she might have a history of what?
Epilepsy
MAOI, what statement by the nurse would be appropriate to include in client education about it
Avoid tyramine containing foods
What are benzodiazepines used for
antianxiety, alcohol withdrawal, muscle relaxant especially before surgery, anticonvulsant
Nurse understands opiate agonists interacts with receptors to produce an analgesic response, an agonist antagonist does what
Stimulates a response and may inhibit other responses
Parkinson’s disease is based on maintaining a balance between what two neurotransmitters?
Dopamine and acetylcholine
The nurse is speaking with a client who has been prescribed percocet, what indicates they need more education? Which statement is not correct?
(Looking for the wrong answer)
I’ll take the narcotic every 4 hours until I run out
Prozac, fluoxetine is an antidepressant that can be used in a variety of settings, how does it work?
Inhibits reuptake of serotonin
Muscle relaxants work where?
Muscle spasms is related to muscle damage or connective tissue damage related to the muscles themselves but muscle relaxants typically work within the nervous system to interfere with that muscle spasm and pain.
Somebody that you are going to give morphine to and what adverse effect would you want to notify the client about
Drowsiness
A nurse understands the risk to direct toxicity of medications, all of the following patients are currently taking lithium as prescribed but which patient is the most at risk for toxicity?
The patient who has been sick with nausea vomiting and diarrhea
The nurse is creating a care plan for someone who is on a selective serotonin reuptake inhibitor, what would be an appropriate nursing diagnosis?
Disturbed thought process related to central nervous system effects
A client has been taking chlorpromazine for several months and is experiencing relief of his symptoms, he states that he’s going to stop taking the medication and see how he feels, what should the nurse advise this client?
Stopping suddenly isn’t safe and can cause very unpleasant symptoms
Muscle spasticity is related to central nervous system nerve damage and muscle spasm is more related to muscle damage or connective tissue damage related to muscle
So that’s why
-someone who over stretched their muscles during their workout or someone who has
-damaged the muscle itself that would be an example of somebody who might be at risk for a muscle spasm and also a client who
-tore a leg tendon during a soccer game.
(Not the person with parkinsons)
Narcotics provide effective pain relief for all of the following reasons except:
Narcotics cause activation in receptors in the central nervous system and thereby cause anelgesia
When learning about pharmacokinetics the nursing student should know it is
The way the body deals with the drug
A nurse is caring for a neonate born with a congenital heart anomaly, to better help the parents understand the impact of this disorder, the nurse begins by describing the usual flow of blood through the heart. What course should the nurse describe?
Oxygenated blood from the lungs enters the left atrium through the pulmonary veins
The nurse explains how the myocardium receives oxygen to the new graduate nurse beginning work in the constant care unit. The nurse explains to the colleague that the coronary arteries receive blood when?
During ventricular diastole
A client diagnosed with heart failure would like the nurse to explain what the diagnosis means. How should the nurse explain heart failure?
The heart muscle cannot pump as effectively as normal, causing a backup of blood
A client asks the nurse what cardiac glycosides do to relieve the symptoms of heart failure, what is the nurse’s best response?
They make your heart contract more forcefully
What nursing considerations are important when caring for a patient on digoxin therapy?
- Serum digoxin level
- Apical pulse for one full minute
- Educate the patient regarding the avoiding ginseng, licorice, and hawthorne
While studying antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is regulated by various elements. What are they?
Heart rate
Stroke volume
Total peripheral resistance
A nurse is administering captopril, an ACE inhibitor, to a client. The client asks the nurse how this medication is supposed to help lower his blood pressure. The nurse answers that Captopril works by:
Blocking the enzyme that converts angiotensin 1 into angiotensin 2, a powerful vasoconstrictor
A patient states that they are experiencing an annoying, persistent dry cough that started once they began taking Captopril. The patient does not report any other signs and symptoms. What is the best response by the nurse?
Reassure the patient that this is a common side effect and not to abruptly stop taking the medication
A client with hypertension has been started on losartan, an Angiotensin 2 receptor blocker, after 6 weeks of therapy, it is decided that the losartan alone is not controlling the client’s hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this client’s hypertension?
Hydrochlorothiazide
A client is being treated for dehydration and asks the nurse how the body maintains proper fluid composition and volume. The nurse should describe which regulatory mechanisms?
Concentration of urine
Secretion of electrolytes
Dilution of urine
A client comes to the clinic for a 1-month follow-up appointment. The client tells the nurse he or she has been taking hydrochlorothiazide for a month and now his leg cramps and “feels tired all the time” what will the nurse consider as the most likely cause of the clients symptoms?
Hypokalemia (low levels of Potassium)
The nurse is educating an older client about reasons the medication furosemide (Lasix) was prescribed. Which of the following statements would be appropriate to include in the education?
The Lasix will help you get rid of that extra fluid that your heart failure is causing
The nurse is caring for a client with decreased blood flow to the kidneys. The client’s blood pressure has been in the range of 150/100 mm Hg for several days. What is the most likely cause of this client’s hypertension?
Release of renin
A client has been diagnosed with angina and prescribed nitroglycerin. What aspect of the client’s health history should prompt the nurse to monitor the client particularly closely after administration of the drug?
Orthostatic hypotension
Goal in treating arrhythmias
to restore normal sinus rhythm and prevent reoccurrence of life threatening arrhythmias
Effectively inhibiting cardiac response to stimulate nerve and reduce heart rate:
Class II
Beta Blockers
Inhibiting sodium ion movement
Class 1
Unresponsive with life threatening ventricular arrhythmia
Amiodarone (class 1 and 3)
Diagnosed with Atrial fibrillation warfarin therapy - lab values that best shows desired effect?
INR 2.7
Coumadin eating salads effects blood coagulation by?
Decrease effectiveness of coumadin -> leads to faster blood clotting
Anticoagulant therapy, teach patient…
Brush teeth with soft brush
Follow up lab work necessary
What are Class IV antiarrythmics?
calcium channel blockers - diltiazem
