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Kaplan NCLEX Review > Pharmacological And Parenteral Therapies > Flashcards

Pharmacological And Parenteral Therapies Flashcards

1
Q

Nursing actions prior to the administration of blood products

A
  • assess for allergies or previous blood reaction
  • type and cross match
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2
Q

Nursing interventions for administration of blood

A
  • obtain baseline vitals
  • use 18 gauge needle for access
  • start with 0.9% NaCl
  • run slowly (5 mL/min) for the first 15 min
  • remain with client during first 15-30 min
  • infuse blood in 4 hours or less
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3
Q

Allergic blood transfusion reactions result from

A

Hypersensitivity

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4
Q

Hemolytic blood transfusion reactions result from

A

Incompatibility

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5
Q

Febrile blood transfusion reactions result from

A

Antibodies to donor platelets or leukocytes

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6
Q

Bacterial blood transfusion reaction results from

A

Contaminated blood

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7
Q

S/S of allergic transfusion reaction

A

Urticaria, pruritis, fever, anaphylactic shock

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8
Q

S/S of hemolytic transfusion reaction

A

N/V, pain in lower back, hypotension, hematuria

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9
Q

S/S of febrile transfusion reaction

A

Fever, chills, nausea, headache, flushing, tachycardia

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10
Q

S/S of bacterial transfusion reaction

A

Tachycardia, hypotension, fever, chills, shock

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11
Q

Nursing interventions for blood transfusion reaction

A
  • stop infusion, restart 0.9% NaCl
  • PRIORITY: airway management
  • administer diphenhydramine, aspirin
  • return blood container to blood bank
  • collect blood and urine sample
  • monitor UO
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12
Q

Which type of transfusion is collected 4-6 weeks before surgery and prevents viral infection and transfusion reactions?

A

Autologous transfusion

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13
Q

Where is venipuncture performed with a PICC line?

A

Above or below the antecubital fossa

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14
Q

Where is the tip of the PICC line catheter placed?

A

In the superior vena cava

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15
Q

How often should the nurse change PICC line dressings?

A

2-3 times/week when wet or nonocclusive

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16
Q

PICC line nursing consideration

A

DO NOT take BP or draw blood from extremity with PICC line

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17
Q

Nontunneled, triple lumen catheter inserted through the subclavian vein for short-term IV therapy

A

Percutaneous central catheter (PCC)

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18
Q

The _________ lumen of a PCC is used to infuse or draw blood samples

A

Distal

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19
Q

The _________ lumen of a PCC is used for PN infusion

A

Middle

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20
Q

The _________ lumen of a PCC is used to infuse or draw blood and administer medication

A

Proximal

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21
Q

How often should the nurse change the catheter site for PCC?

A

Every 4 weeks

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22
Q

How often should the nurse change PCC tubing?

A

Every 72-96 hours

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23
Q

S/S of infiltration

A

Cool skin, swelling, pain, decreased flow rate

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24
Q

Nursing interventions for infiltration

A
  • D/C IV
  • apply warm compresses to site
  • elevate arm
  • start new IV proximal to infiltrated site
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25
Q

S/S of phlebitis/thrombophlebitis

A

Redness, warm, tender, swelling, leukocytosis

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26
Q

Nursing interventions for phlebitis/thrombophlebitis

A
  • D/C IV
  • apply warm, moist compresses
  • restart IV at new site
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27
Q

S/S of hematoma

A

Ecchymosis, swelling, leakage of blood

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28
Q

Nursing interventions for hematoma

A
  • D/C IV
  • apply ice for 24 hr, followed by warm compress
  • restart IV in opposite extremity
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29
Q

S/S of clotted IV

A

Decreased flow rate, backflow of blood into tubing

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30
Q

Nursing interventions for clotted IV

A
  • D/C
  • DO NOT: irrigate, milk, increase rate of flow, hang solution higher, aspirate cannula
  • inject urokinase to dissolve clot
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31
Q

Examples of isotonic fluids

A

0.9% NaCl, LR, D5W (becomes hypotonic when glucose is metabolized)

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32
Q

Example of hypotonic fluids

A

0.45% NaCl

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33
Q

Example of hypertonic fluid

A

D10W

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34
Q

How often should IV tubing be changed?

A

Every 72 hours

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35
Q

How often should IV bag be changed?

A

Every 24 hours

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36
Q

Hives, rash, difficulty breathing, and diaphoresis are all symptoms of

A

Anaphylaxis

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37
Q

Nursing interventions for anaphylaxis

A
  • administer epinephrine IM
  • massage site to speed absorption
  • may repeat in 15-20 min
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38
Q

S/S of liver impairment

A

Fever, malaise, N/V, jaundice, light stools, dark urine, abdominal pain, elevated AST & ALT, altered PTT

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39
Q

S/S of renal impairment

A

Elevated BUN and creatinine, decreased Hct, altered electrolytes (K+, Na), altered urinary output, edema

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40
Q

Nursing interventions for renal impairment

A
  • diet and fluid restriction
  • electrolyte replacement
  • dialysis
  • rest
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41
Q

Anticholinergic side effects

A

Blurred vision, dry mouth, dysphagia, urinary retention, constipation, impotence, nasal congestion

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42
Q

Parkinson’s-like side effects

A

Akinesia, tremors, drooling, changes in gait, rigidity, akathisia, dyskinesia

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43
Q

Aluminum hydroxide, magnesium hydroxide, calcium carbonate, and aluminum/magnesium hydroxide are all examples of

A

Antacids

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44
Q

Key side effects of antacids

A

Constipation (calcium carbonate), diarrhea (magnesium), acid rebound

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45
Q

Antacid nursing considerations

A
  • interferes with absorption of antibiotics, iron preparations, INH, oral contraceptives
  • monitor bowel function
  • use cautiously in clients with renal disease (particularly magnesium)
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46
Q

Chlordiazepoxide, alprazolam, lorazepam, and diazepam are all examples of

A

Benzodiazepines

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47
Q

Examples of non-benzodiazepines

A

Hydroxyzine and buspirone

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48
Q

Herbal supplements for anxiety

A

Kava and melatonin

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49
Q

Benzodiazepine side effects

A

Sedation, confusion, dizziness, hepatic dysfunction

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50
Q

Benzodiazepine nursing considerations

A
  • potential for addiction/overdose
  • for short-term use
  • use cautiously in patients who are suicidal or with a history of addiction
  • monitor liver function; use cautiously in patients with liver dysfunction
  • not to be used in conjunction with MAOI
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51
Q

Benzodiazepine patient education

A
  • avoid alcohol or other CNS depressants
  • do not drive or operate heavy machinery
  • gradually taper dose if changing or discontinuing med
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52
Q

Antibiotic nursing considerations

A
  • obtain culture and sensitivity prior to initiation of antibiotic therapy
  • assess for allergies
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53
Q

Antibiotic patient education

A
  • take exactly as prescribed
  • complete the full course of therapy
  • increase fluid intake
  • may decrease effectiveness of oral contraceptive
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54
Q

Gentamicin, neomycin, streptomycin, and tobrabycin are all examples of

A

Aminoglycosides

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55
Q

Aminoglycoside side effects

A

Ototoxicity, nephrotoxicity, anorexia, N/V, diarrhea

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56
Q

Aminoglycoside nursing considerations

A
  • assess 8th cranial nerve (hearing — d/t ototoxicity)
  • monitor BUN and creatinine
  • encourage fluids
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57
Q

Cefaclor, cefazolin, cephalexin, ceftriaxone, and cefoxitin are all examples of

A

Cephalosporins

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58
Q

Cephalosporin side effects

A

GI disturbances, increased bleeding time, rash, superinfection

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59
Q

Cephalosporin nursing considerations

A
  • administer with food
  • educate pt to avoid alcohol
  • assess for penicillin allergy
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60
Q

Ciprofloxacin an levofloxacin are examples of

A

Fluoroquinolones

61
Q

Fluoroquinolones side effects

A

Diarrhea, decreased WBC and Hct, elevated liver enzymes, elevated alkaline phosphatase, Achilles tendon rupture

62
Q

Nursing considerations for levofloxacin

A
  • administer 2 hr before/after antacids & iron-containing products
  • monitor theophylline levels (may increase theophylline levels)
  • monitor glucose (can increase effect of oral hypoglycemics)
63
Q

Erythromycin and azithromycin are examples of

A

Macrolides

64
Q

Macrolide side effects

A

Diarrhea, confusion, hepatotoxicity, superinfections

65
Q

Macrolide nursing considerations

A
  • monitor liver function
  • medication interactions: warfarin, verapamil
66
Q

Side effects of penicillins

A

Stomatitis, diarrhea, allergic reactions, renal and hepatic changes

67
Q

Penicillin nursing considerations

A
  • check for hypersensitivity
  • cross allergy with cephalosporins
68
Q

Trimethoprim/sulfamethoxazole and Sulfasalazine are examples of

A

Sulfonamides

69
Q

Sulfonamide side effects

A

Crystalluria, photosensitivity, GI upset, stomatitis, hypersensitivity, bone marrow depression, Steven Johnson syndrome

70
Q

Sulfonamide nursing consideration

A
  • encourage fluid (to prevent crystalluria)
  • provide good mouth care (d/t stomatitis)
  • interactions: oral hypoglycemia sulfonylurea, warfarin — increases effects of these meds
71
Q

Tetracycline side effects

A

Discoloration of primary teeth, glossitis, rash, photosensitivity

72
Q

Tetracycline nursing considerations

A
  • client should not take with antacids, milk, or iron
  • contraindicated in pregnancy
  • monitor renal function
  • educate client to avoid sunlight
73
Q

Propantheline, atropine, scopolamine, and Benztropine are examples of

A

Anticholinergics

74
Q

Anticholinergic MOA

A
  • pupil dilation
  • bronchodilation
  • decreases secretions, mobility, and GI secretions
75
Q

Anticholinergic nursing considerations

A
  • monitor output
  • contraindicated with glaucoma
  • provide good mouth care (d/t dry mouth)
  • abdominal assessment
  • educate patient to consume plenty of fluids and fiber
76
Q

Heparin nursing considerations

A
  • monitor platelets and PTT
  • administer SC or IV
  • antidote: protamine sulfate
  • monitor for excessive bleeding and tissue irritation
77
Q

Warfarin nursing considerations

A
  • monitor PT/INR
  • antidote: Vitamin K
  • avoid foods high in vitamin K (leafy greens, dairy products)
  • monitor for bleeding
  • administer PO
  • herbal supplement interactions: garlic, ginger, gingko, and ginseng
78
Q

Phenytoin, phenobarbital, valproic acid, carbamazepine, and clonazepam are all examples of

A

Anticonvulsants

79
Q

Anticonvulsants side effects

A

Respiratory depression, aplastic anemia, gingival hyperplasia (phenytoin), ataxia, sedation

80
Q

Anticonvulsant nursing considerations

A
  • implement seizure precautions
  • teach client not to d/c abruptly; take daily as prescribed
  • monitor serum levels
  • monitor CBC (d/t risk for aplastic anemia)
81
Q

Phenelzine, isocarboxazid, and tranylcypromine are examples of

A

MAOIs

82
Q

MAOI side effects

A

Hypertensive crisis (d/t consumption of foods containing tyramine), photosensitivity, sexual dysfunction

83
Q

MAOI nursing considerations

A
  • teach client to avoid foods containing tyramine: aged cheese, bologna, pepperoni, salami, bananas, chocolate, raisins, beer, wine, pickled products
  • monitor BP
  • educate client that may take up to 4 weeks for therapeutic effect
84
Q

Fluoxetine, paroxetine, and sertraline are examples of

A

SSRIs

85
Q

Venlafaxine and duloxetine are examples of

A

SNRIs

86
Q

SSRI side effects

A

Anxiety, GI upset, change in appetite and bowel function, urinary retention/dry mouth, sexual dysfunction

87
Q

SSRI nursing considerations

A
  • suicide precautions
  • instruct client that it may take up to 4 weeks for therapeutic effects
  • administer in a.m. (d/t insomnia)
88
Q

Amytriptyline and imiprimine are examples of

A

Tricyclic antidepressants

89
Q

Tricyclic antidepressant side effects

A

Sedation, anticholinergic effects, confusion, postural hypotension, photosensitivity, bone marrow depression

90
Q

Tricyclic antidepressant nursing considerations

A
  • suicide precautions
  • takes 2-6 weeks for therapeutic effect
  • administer at bedtime
  • monitor vitals and labs
  • do NOT abruptly d/c
91
Q

Bupropion and trazodone are examples of

A

Atypical antidepressants

92
Q

Side effects of atypical antidepressants

A

Dry mouth, nausea
Bupropion: insomnia & agitation
Trazodone: sedation & orthostatic hypotension

93
Q

Atypical antidepressant nursing considerations

A
  • client should avoid alcohol and CNS depressants
  • wean off slowly
94
Q

Bismuth subsalicylate, diphenoxylate/atropine, loperamide, and opium alkaloids are examples of

A

Antidiarrheals

95
Q

Antidiarrheal side effects

A

Constipation, anticholinergic effects

96
Q

Antidiarrheal nursing considerations

A
  • do not use with abdominal pain
  • monitor for urinary retention
  • give 2 hr before or 3 hr after other meds
97
Q

Quinidine, lidocaine, flecainide, propranolol, amiodarone, and verapamil are examples of __________ medications

A

Antidysrhythmic

98
Q

Antidysrhythmic side effects

A

Lightheadedness, hypotension, bradycardia, urinary retention

99
Q

Side effects of propranolol

A

Bradycardia, bronchospasm (use cautiously in patients with asthma)

100
Q

Side effects of amiodarone

A

Photosensitivity, photophobia

101
Q

Side effect of verapamil

A

Heart failure

102
Q

Antidysrhythmic nursing considerations

A
  • monitor BP and HR
  • monitor cardiac rhythm
  • prevent orthostatic hypotension (well hydrated, change positions slowly)
  • assess HR prior to administration (beta blocker); hold if HR < 50
  • DO not break, crush, or chew meds
103
Q

Trimethobenzamide, prochlorperazine, Metoclopramide, meclizine, and Ondansetron are examples of

A

Antiemetics

104
Q

Antiemetics side effects

A

Sedation, anticholinergic effects

105
Q

Amphotericin B, nystatin, and fluconazole are examples of

A

Antifungals

106
Q

Antifungal side effects

A

Hepatotoxicity, thrombocytopenia, leukopenia

107
Q

Antifungal nursing consideration

A
  • used cautiously in immunocompromised patients
  • administer with food (unless swish and swallow)
  • monitor liver function
  • educate patient to complete prescription
108
Q

Colchicine, probenecid, and allopurinol are examples of

A

Antigout medications

109
Q

Antigout medication side effects

A

Agranulocytosis, aplastic anemia, GI upset, renal calculi

110
Q

Antigout medication nursing considerations

A
  • monitor for renal calculi
  • increase PO fluid intake
  • give with milk, food
  • dietary restrictions: alcohol, caffeine, purines (increase uric acid levels) — organ meats, foods made from yeast
111
Q

Diphenhydramine and promethazine are examples of

A

Antihistamines

112
Q

Antihistamine side effects

A

Drowsiness, dry mouth (anticholinergic effects), GI upset, bronchospasm

113
Q

Antihistamine nursing considerations

A
  • give with food
  • assess respirations
  • client should avoid alcohol
114
Q

Beta blocker nursing considerations

A
  • take with meals
  • do not d/c abruptly
  • masks signs of hypoglycemia in clients with diabetes
  • nonselective can cause bronchospasm
115
Q

Candesartan, losartan, and eprosartan are examples of

A

ARBs

116
Q

Doxazosin and prazosin are examples of

A

Alpha 1 adrenergic blockers

117
Q

Cholestyramine and atorvastatin are examples of

A

Antilipidemics

118
Q

Antilipidemic side effects

A

Constipation, fat-soluble vitamin deficiency, muscle cramps

119
Q

Antilipemic nursing consideration

A

Monitor triglyceride and liver function tests

120
Q

When should digoxin be held?

A

Adult: HR < 60
Older Children: HR < 70
Infants and Young Children: < 90-110

121
Q

Key side effects of Acetazolamide (carbonic anhydrase inhibitor for open-angle glaucoma)

A
  • pulmonary edema
  • decreased K+ level
  • blurred vision
  • lethargy
  • depression
122
Q

Herbal supplement that works on the immune system to prevent and treat colds/flu/UTI and promotes wound healing

A

Echinacea

123
Q

Echinacea side effects

A

Allergic reaction, N/V, unpleasant taste with tingling on tongue

124
Q

Echinacea nursing considerations

A
  • decreases effectiveness of immunosuppressants
  • contraindication in autoimmune diseases
  • avoid if allergic to ragweed/daisies
125
Q

Herbal supplement that is anti-microbial, -lipidemic, -thrombotic, -tumor, and -inflammatory

A

Garlic

126
Q

Garlic side effects

A

Flatulence, heartburn, irritation of mouth, esophagus, and stomach, allergic reaction

127
Q

Garlic nursing considerations

A
  • may potentiate anticoagulants, antiplatelets, antidiabetics, antihyperlipidemics, antihypertensives
  • avoid if allergy to Lillie’s
  • may decrease effectiveness of oral contraceptives
128
Q

Herbal supplement that provides analgesia, improves circulation, and alleviates nerve pain

A

Capsicum/Cayenne Pepper

129
Q

Capsicum side effects

A

GI discomfort, self-defense — pain/burning in eye, skin, cough, bronchospasm

130
Q

Capsicum nursing considerations

A
  • may decrease effectiveness of antihypertensives
  • increase risk of cough with ACE inhibitors
  • potentiate antiplatelet meds
  • hypertensive crisis with MAOIs
  • increase theophylline absorption
131
Q

Herbal supplement that acts as an antidepressant, sedative, antiviral, and antimicrobial

A

St John’s Wort

132
Q

Side effects of St John’s Wort

A

Photosensitivity, fatigue, allergic reaction, restlessness

133
Q

St John’s Wort nursing considerations

A
  • decreases effectiveness of digoxin, Antineoplastic, antivirals, AIDS meds, antirejection meds, theophylline, Coumadin, oral contraceptives
  • contraindicated in SSRIs, MAOIs, and major depression
134
Q

What medication can be used to control bleeding related to thrombolytics?

A

Aminocaproic acid

135
Q

Which iron preparation is exclusively administered IM or IV when the client cannot tolerate PO administration?

A

Iron dextran

136
Q

How should clients take iron?

A

On an empty stomach, with orange juice (vitamin C increases absorption)

137
Q

Foods high in iron

A

Cereals, dried beans/legumes, dried fruit, green leafy vegetables, lean red meat and organ meats

138
Q

What can decrease the absorption of iron?

A

Antacids, coffee, tea, milk, and eggs

139
Q

Lithium nursing considerations

A
  • monitor serum levels (2-3 times/week when starting, monthly for maintenance)
  • monitor sodium levels (risk for hyponatremia)
140
Q

S/S of lithium toxicity

A

Initial: persistent N/V/D, ataxia, blurred vision, slurred speech
Progression: worsening tremors, mental confusion, stupor
Severe: seizure, coma, cardiac dysrhythmias, circulatory collapse

141
Q

Clients taking rapid-acting insulins (lispro, aspart, glulisine) need to eat within ___-___ minutes of injection time

A

5-15

142
Q

Clients taking regular insulin need to eat within ___-___ minutes of injection time

A

20-30

143
Q

What medications decrease insulin needs?

A

MAOIs, aspirin, and anticoagulants

144
Q

Ingestion of alcohol during metformin therapy can lead to

A

Lactic acidosis

145
Q

Medications that can elevate glucose levels necessitating higher doses of insulin

A

Thiazide diuretics, glucocorticoids (cortisone), thyroid medications, estrogen

146
Q

Laxative/stool softeners contraindications

A

Symptoms of acute abdominal pain, N/V, and fever

147
Q

What electrolyte imbalance can result from chronic use of stool softeners/laxatives?

A

Hypokalemia

148
Q

Ulcer medication (H2 blockers, PPI) nursing considerations

A
  • do not administer along with antacids
  • best administered at bedtime (suppresses nocturnal acid secretions)
  • can cause confusion in the elderly
  • caffeine, ASA, smoking, and alcohol increase stomach acid inhibiting absorption

Kaplan NCLEX Review (6 decks)

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