pharm- medical surgical drugs Flashcards
(13 cards)
The following ngn case study is going to be on medical-surgical medications
question 1
digoxin is prescribed for a client with heart failure. The nurse will assess for which clinical manifestation that includes digoxin toxicity? select all that apply. (6)
- confusion
- headache
- nausea
- yellow vision
- dizziness
- irregular pulse
- increased urine output
- decreased respiratory rate
tell me why
tell me why not
what’s the protocol on giving digoxin?
- confusion
- headache
- nausea
- yellow vision
- dizziness
- irregular pulse
patient would have a decreased cardiac output, meaning it wouldn’t be increased urine output, it would be decrease urine output
changes in respiratory rate doesn’t matter and its not affected for digoxin toxicity
- additional, patients are going to have bradycardia
heart rate greater than 60, and given to patient with heart failure
question 2 is about a patient who receives chemo for her cancer and has developed bone marrow suppression’s. The nurse will monitor for which thrombocytopenia effect? select all that apply ? (3)
- fatigue
- pale skin
- DVT
- dizzines
- melena
- purpura
- emboli
- hematuria
why those 3
and not the rest
how does bone marrow suppression occur?
bone marrow suppression’s results in a reduced number of circulating white and red blood cells, as well as platelets.
black tarry feces - known as melena, is caused by an intestinal secretions on blood are associated with bleeding in the GI tract , bleeding is related to reduced number of thrombocytes, which are needed to help coagulate
again with the pupura
the lack of thrombocytes causes brushing on the skin to be easier
same thing with the hematuria, lack of thrombocytes, we will see blood in the urine
the rest of the signs are associated when you have low red blood cells, so anemia
DVT and emboli are effects of thrombocytosis
question 3
a client is prescribed ARB medication to aid with treating his hypertension. which instruction will the nurse provide about this medication? select all that apply (5)
- monitor the blood pressure often
- discontinue treatment if a cough develops
- stop the medication if swelling of the mouth, lips or face develops
- have blood drawn for potassium levels 2 weeks after staring the medication
- do not take with NSAIDS
- notify other prescribes of new arb medication
- report lightheadedness or dizziness upon standing to the provider
- serum levels will be drawn at least once a month to ensure therapeutic levels
tell me why and why not for each
- monitor the blood pressure often
- stop the medication if swelling of the mouth, lips or face develops
- have blood drawn for potassium levels 2 weeks after staring the medication - notify other prescribes of new arb medication
- report lightheadedness or dizziness upon standing to the provider
we want to monitor blood pressure frequency because you are taking a medication in hopes to lower it, so seeing the bp frequency can help us give an estimate to what to expect
stop the medication when you are having an allergic reaction, like swelling of the lips, mouth and face (angioedema)
electrolytes levels of potassium, sodium and chloride should be monitored 2 weeks after therapy then periodically there after
you want to notify any other doctors that you got a new medication incase of drug interaction and possible additional medications needed
report any lightheadedness or dizziness upon standing to the provider cause it can show signs of othostatic hypotension, which is common in arb medications
now the no’s
- a dry cough is common however no need to stop taking the medication, usually just drink more water
no need to avoid saids
and serum levels are not needed to be monitored with the use of arb
question 4 on the ngn case study talks about how a healthcare provider prescribes aspirin therapy for a client with arthritis. the nurse will advise the client to report which adverse effect immediately? select all that apply. (4)
- ongoing nausea
- diarrhea
- easy bruising
- decreased pulse
- sour stomach
- ringing in the ears
- trouble sleeping
- dry mouth
tell me why
tell me why not
what is aspirin known for ?
what does aspirin do?
- ongoing nausea
- diarrhea
- easy bruising
- ringing in the ears
aspirin is known as a gi irritant that can cause nausea, vomitting and gi bleeding
salicylates decrease platelet aggregation - resulting in easy bruising and bleeding
tinnitus and hearing loss can occur as a result of effects of the medication on the 8th cranial nerve
no the no’s and why’s
- aspirin can increase the heart rate
- sour stomach, trouble sleeping, and dry mouth are all known side effects of aspirin and dont need immediate medical attention
question 5 on the ngn case study talks about a patient who is in pain and is prescribed morphine. which clinical finding warrants immediate action by the nurse?
select all that apply (3)
- polyuria
- unconsciousness
- bradycardia
- dilated pupils
- bradypena
- hypertension
- yawning
- lacrimation
-unconsciousness
- bradycardia
- bradypnea
if morphine is overdosed, it can cause unconsciousness
morphine is known as a vasodilator/CNS depressant so seeing the patient have a low heart rate is expected
morphine can lower respirations, so bradypnea is expected but should be assessed
morphine doesn’t increase urine output
morphine causes constriction of the pupils
it causes hypotension not hypertension
yawning, lacrimation, rhiniorrhea are symptoms of withdrawal from morphine or other opioids
question 6 is about a client who is experiencing hypothyroidism event.
what 2 actions are expected by the nurse
- review client tsh level
- monitor client hr
- request order for metoprolol
- review client white blood cell count
- monitor client urinary output
what are 2 client medication education on synthoid we should teach the client ?
- do not switch brand of medication
- take on an empty stomach 1 hour before breakfast
- do not take if symptoms improve
- may decrease heart rate
- take with antacid if stomach upsets occurs
tell me why for each
tell me why not for each
- review client tsh level
- monitor client hr
- do not switch brand of medication
- take on an empty stomach 1 hour before breakfast
the client has been prescribed levothyroxine, which is a synthetic hormone replacement medication that is given when a patients t3 and t4 levels are low and TSH is normal or high. So its indicted to double check their levels before giving more medication.
levothyroxine therapy can cause a high heart rate, because the drug raises metabolism and cardiac output. so watching for their heart rate to increase is indicated.
the drug should be taken on an empty stomach 30-60minutes before breakfest in order for maximum absorption and stimulate body rise of thyroid activity upon waking.
switching brands of thyroid drug is not suggested unless guidance by a provider
now the no’s and why’s
- an order for metoprolol is not indicated because the patients blood pressure was not low and would increase the hypothyroid effects of bringing it lower
there is no sign of inflammatory or infectious disease so white blood cell count is not needed
the urinary output is not required
taking an antacid would decrease the absorption of the medication
question 7
a 70 year old male client present in the emergency department with
- shortness of breath
while tree trimming an hour ago. the client stats
- my heart feels like its flip flopping
client has a past medical history of hypertension, for which he takes metoprolol 50mg daily. client additional states he has been urinating more frequently throughout the night and he has had a dry cough for the past week.
vital signs
pulse - 118 !!
bp - 138/88
spO2 - 92% room air
temp - 98
pulse irregular
capillary refill 2 seconds
skin warm and dry
alert and orientated
why do you think we selected the ones that we did for immediate attention
shortness of breath
my heart feels like its flip flopping
heart rate of 118 beats
shortness of breath can indicate respiratory issues and lack of perfusion
heart flip flopping can be pain and maybe even lead to a stroke or a heart attack
heart rate above 118 is tachycardia
question 8 is the same as question 7 in the sense of the patient.
however, which problem would the nurse consider the client to be at risk for after reviewing the nurses notes? (4)
- ischemic stroke
- hemorrhagic stroke
- angina
- myocardial infarction
- heart block
- myxedema crisis
- acute kidney failure
- risk for falls
why did we select these four and not the others ones?
- ischemic stroke
- angina
- myocardial infarction
- risk for falls
a rapid heart rate and irregular pulse can contribute to blood statsis, increasing the risk of developing a blood clot in the Atria - resulting in a ischemic stroke
it can decreased cardiac output, meaning decrease perfusion and oxygen supply to the heart causing chest pain - angina and worse - heart attack if its blocked
decreased cardiac output may result in decreased blood flow to the brain, causing dizziness and risk for falls
now the no’s
hemorrhagic stroke is bleeding - client is not bleeding anywhere
heart block is a dysrphtymia and usually cause by a previous heart attack, but the client hasn’t had that
client does not have myxedema crisis - a form of hypothyroidism
acute kidney failure is a sudden loss of kidney function, which would resulted in decreased urine output, but the client has nocturia ( pee at night ) so it wouldn’t apply
question 9 is still on the same patient as before
complete the following sentences by using the list of options below
the client is experiencing
- decreased cardiac output
and
- lightheadness
caused by
- atrial fibrillation
tell me why we choose these options
lightheadness is caused by decreased cardiac output and its subsequent decreased tissue perfusion
a-fib with tachycardia does not allow adequate ventricular filling time, which reduces stroke volume and perfusion to heart and brain
question 10 is for the same patient again
click which 3 orders the nurse would perform right away and why
- administer diltiazem 0.25mg/kg
- apply and titrate oxygen to maintain oxygen saturation > 92%
- bed rest with bathroom privileges
- continuous cardiac monitoring
- initiate iv access
- insert indwelling urinary catheter
- administer diltiazem 0.25mg
- continuous cardiac monitoring
- initiative iv access
we are giving the medication in order to decreased the clients heart rate
continuous cardiac monitoring is needed, cause one tis already high and we need to watch for dysrthhymia and we need to watch if the medication is working
we need iv access to even give the medication
the oxygen is at 92, and we need to supply more
bed rest with bathroom priviliges order only requires the nurse to ensure the client ambulates only to the bathroom, which does not address the clients need for increased tissue perfusion
indwelling Cath would reduce the risk for falls but its not important right now
question 11 is saying if its indicated, nonidciated or contraindicated
- asses for headache
- prepare client for transcutaneous pacing
- educate patient about signs of stroke
- consult occupational therapy
- administer atropine sulfate as ordered
- obtain order for rivaroxban
tell me why for each
indiciated
contra
indicated
not indiciated
contra
indicated
headache is common after diltiazem therapy
no need to do a transcutaneous pacing, its usually for Brady-dysrhytmias, the patient is tachy
a-fib can lead to stroke, so education is needed
therapy for walking is not really needed, but can help improve, but not really the first thing to worry about
atropine is for bradycardia and to reverse effects of acetylcholine, the patient is tachy, so contra cause it’ll go up
rivaroxaban is an anticoagulant and will help prevent clot formation, and reduce the risk of ischemic stroke from a-fib
question 12
is it effective
is it ineffective
is it unrealted
- hr 82
- irregular pulse 2+
- cough
- cap refill 3 seconds
- oxygen 98
effective
ineffetive
unrealted
ineffective
effective
hr dropped so good
still bad pulse - not good
he never had a cough
cap refill being 3 seconds is bad cause it use to be 2
oxgeyn saturation 98 is good cause it use to be 92
