Pharm NCLEX review

Question 1

What drug class is good for symptoms of alcohol withdrawal? In particular, what drug from within that class is best? Why?

Answer 1

Benzodiazapines

Chlordiazapoxide

It has a longer half-life than other benzos

Question 2

Why would the rheumatoid arthritis med infliximab be contraindicated in a person with Hep B?

Answer 2

It is a tumor necrosis factor antibody med and causes immunosuppression. If a person has an infection such as Hep B then infliximab could suppress the body’s immune reation.

Question 3

What is the indicataion for amantadine? What is a drug used to treat schizophrenia that can have Parkinsonian adverse effects?

Answer 3

Parkinsonian symptoms and extrapyramidal manifestions?

chlorpromazine

Question 4

What is the MOA of dobutamine hydrochloride? And what would be its therapeutic effect on a client with heart failure?

Answer 4

vasopressor

it improves cardiac output which improves the hemodynamic status

Question 5

What is the MOA of lactulose? How could it be helpful in treating someone with cirrhosis?

Answer 5

a laxative that decreases ammonia levels by increasing intestinal ammonia secretions

helps make up for the lack of effectiveness of the liver’s ability to process ammonia

Question 6

What is cycloplegia? What med can cause this effect? Why? What would the client report if they were experiencing this AE?

Answer 6

inability to accommodate from far to near vision

atropine

paralyzes the ciliary muscles

blurred vision

Question 7

Why is the PUD med misoprostol categorized as a pregnancy X?

Answer 7

It can stimulate uterine contractions and cause a spontaneous abortion

Question 8

Why are opioid pain relievers and benzo incompatible and should not be taken together?

Answer 8

both cause respiratory depression

Question 9

What can cause digoxin-induced dysrhythmias? What is commonly prescribed if client is taking a diuretic concurrently with digoxin? What is generally the fiest manifestations of digoxin toxicity? CNS toxicity effects of dig?

Answer 9

hypokalemia
increased digoxin blood levels
heart disease

potassium
or potassium-sparing diuretic like spironolactone

anorexia
N/V
abdominal pain

fatigue and weakness
vision changes such as blurred vision and/or halos

Question 10

What drug class is filgrastim? MOA? When would this be helpful?

Answer 10

leukopoietic growth factors

stimulates bone marrow to increase production of neutrophils

in decreasing the chance of infection in cancer and other conditions where neutropenia occurs
and to help build of neutrophils for autologous stem cell transplant

Question 11

What meds are alpha-adrenergic antagonists that can treat BPH and urinary hesitancy? MOA? What symptoms will the client likely experience taking this drug?

Answer 11

the -osins like tamsulosin, alfuzosin, terazosin, doxazosin

vasodilation which can lower HTN and increase urinary flow

hypotension, dizziness, nasal congestion, faintness, sleepiness, problems with ejaculation

Question 12

What is NMS? Manifestations? Nursing actions?

Answer 12

neuroleptic malignant syndrome, life-threatening adverse effect. Can occur with antipsychotics.

sudden high-grade fever
change in BP
dysrhythmia, tachycardia
muscle rigidity
diaphoresis
change on LOC, coma

stop med
monitor VS
apply cooling blankets
antipyretics
increase fluids
benzos fr anxiety
dantrolene to relax muscles
ICU
wait 2 weeks to resume therapy

Question 13

What are anticholinergic effects? (think slowing down)

Answer 13

dry mouth
blurred vision
tachycardia
urinary retention
photophobia (dilated pupils)
conspipation

Question 14

What is the prototype biphosphonate?MOA? Therapeutic effect? Side effects? What can decrease its absorption and should not be taken together? How much time should be allowed between taking these meds/foods? What should it be supplemented with?

Answer 14

alendronate

decreases the number and action of osteoclasts, inhibiting bone resorption

osteoporosis

esophagitis, ulcerations
abd. pain, N/V, constipation
bone pain
blurred vision, eye pain

calcium
iron
mag
antacids
OJ
caffeine

2 hours

calcium/vit D
weight bearing exercise

Question 15

What meds can interact with St John’s Wort? What can result? What meds can St. John’s Wort affect effectiveness with concurrent use?

Answer 15

antidepressants, amphetamines, cocaine

serotonin syndrome

oral contraceptions
cyclosporine
warfarin
digoxin
CCBs
steroids
HIV protease inhibitors/anticancer

Question 16

What is the non-insulin injectable antidiabetic prototype? Therapeutic use? What is the greatest risk when used concurrently with insulin or other antidiabetic meds? Administration instructions?

Answer 16

pramlintide and other -tides

supplemental glucose control for T1 and T2 by decrease gastric emptying of glucagon

hypoglycemia

administer prior to meals
wait 1-2 hours to administer other oral meds to prevent disruption of their absorption
refrigerate the unsed portion for up to 28 days

Question 17

What is agranulocytosis? What med can help reverse it? S/S?

Answer 17

dangerously low levels of neutrophils

filgrastim

sore throat, fever, infection symptoms

Question 18

What do the -sartan meds do? Therapeutic use?

Answer 18

they are angiotensin receptor blockers that block the action of angiotensin II in the body causing vasodilation and excretion of sodium and water d/t decreased aldosterone

HTN, heart failure
stroke nd MI aprevention
delays the progression of diabetic neuropathy and retinopathy

Question 19

What med reduces prostate size and increases hair growth? Complication?

Answer 19

finasteride

decreased libido and ejaculate volume

Question 20

What can be given as a pretreatment for the complications of the antifungal amphotericin B?

Answer 20

diphenhydramine and acetominophen

Question 21

What are important client instructions to avoid lithium toxicity? S/S of toxicity?

Answer 21

adequate fluid and sodium intake
emphasize high risk for toxicity so keep the level check appts.
monitor for s/s and contact provider

D/V
excessive sweating
tremors
increased thirst/urination
rash

Question 22

What is the risk of the -ozoles that treat GERD? S/S?

Answer 22

hypomagnesemia

muscle cramps
tachycardia
hyperactive DTR
insomnia

Question 23

When is the administration of atropine appropriate during CPR? When is the administration of epinephrine appropriate during CPR?

Answer 23

symptomatic bradycardia
hemodynamically unstable

asystole
pulseless electrical activity

Question 24

What is the MOA of epinephrine and dopamine? Therapeutic use?

Answer 24

Alpha and Beta 1 receptors

HF, shock

hypertensive crisis leading to cerebral hemorrhage
dysrhythmias, increases workload of the heart

Question 25

What are S/S of NMS? Order of nursing actions?

Answer 25

sudden high-grade fever
autonomic instability such as BP fluctuations and dysrhythmias
muscle rigidity
diaphoresis
tachycardia

stop antipsychotic
monitor VS
apply cooling blankets
administer antipyretic
increase fluid intake
diazepam for anxiety
dantrolene to relax muscles
transfer to ICU
wait 2 weeks before resuming therapy

Question 26

With MAOIs, what foods are restricted? Examples?

Answer 26

tyramine containing foods

cheese and cured meats

Question 27

What is the concerning side effect of the “pril” ace inhibitors and should be reported? What causes it? Other side effects?

Answer 27

cough

inhibition of kinase can result in increase of bradykinin

1st dose orthostatic hypotension
hyperkalemia
rash, dysgeusia (altered taste)
angioedema (swelling of tongue and oral pharynx
neutropenia

Question 28

What is the MOA of propranolol? Adverse effects? Contraindicated in who?

Answer 28

beta blocker

hypotension
bradycardia
HF
AV block
sinus arrest
fatique
bronchospasm

asthma (because of bronchospasms)

Question 29

What is the therapeutic use of clonidine? Complications? Client education? Similar meds?

Answer 29

HTN
sever cancer pain

drowsiness
dry mouth
rebound HTN if abruptly stopped

be compliant
dry mouth resolves in 2-4 weeks
chew gum, ice chips

methyldopa
guanfacine

Question 30

What is aPTT? Normal value range? What med requires monitoring of aPTT?

Answer 30

partial thromboplastin time

1.5-2X the baseline

Heparin

Question 31

What is the is the preferred site for up to 1 mL of I injection? 2mL

Answer 31

deltoid

ventrogluteal

Question 32

What is nursing care with TPN?

Answer 32

adjusting flow rate/abruptly stopping is contraindicated (can alter glucose levels)
assess VS q4-8hr
change tubing and solution q24h
ensure tubing filter
dedicated line
sterile technique when changing central line dressing
check glucose q4-6h
keep dextrose 10% at bedside

Question 33

What manifestations would you see with a right-hemisphere distrubance? Left-sided?

Answer 33

altered perception deficits (overestimate abilities)
left-sided neglect
loss of depth perception
poor impulse control and judgement
visual changes

aphasia
agnosia (unable to recognize familiar objects
alexia (reading difficulty)
agraphia (writing)
right-sided hemiplegia
slow, cautious behavior
depression, anger, quick to become frustrated
visual changes

Question 34

What are the precautions with meningitis? Is meningitis reported to the health department? Complications of menigitis? Nursing actions to prevent these complications?

Answer 34

droplet until antibiotics have been administered for 24 hours
with bacterial may remain on droplet otherwise standard after 24 hrs

yes

ICP
SIADH
septic emboli leading to DIC or stroke

HOB 30 degrees
no sneezing or coughing
monitor for indications (LOC, extraocular movements or pupillary changes)
Possible mannitol
monitor daily weights and I&O
Monitor circulatory status, cap refill regualarly
report alterations immediately

Question 35

What are MS manifestations?

Answer 35

fatigue
pain or parethesia
vision changes
tinnitis
vertigo
dysphagia
dysarthria (slurred or nasaly speech)
muscle spasms
ataxia or muscle weakness
bowel/bladder dysfunction
cognitive changes such as memory loss or impaired judgement
sexual dysfunction

Question 36

What are the manifestations of lithium toxicity?

Answer 36

N/V/D, polyuria, muscle weakness leading to seizures and death

Question 37

Which cranial nerves affect extraocular movements?

Answer 37

oculomotor
trochlear
abducens

Question 38

What can bupropion adversely lower? Who should be prescribed this with caution?

Answer 38

seizure threshold

past head injuries
seizure disorder