PHARMACOLOGY

Question 1

Carbamazepine

Antiepileptic and Mood stabilizer

Answer 1

Adverse Finding SEDATION

This medication requires therapeutic drug monitoring, and the level should be maintained between 8-12 mcg/mL

NO Grapefruit

Should be taken with at least 6 to 8 ounces of fluid
and with food, meals, or a snack **

Question 2

Hydralazine
vasodilation

Answer 2

1. Check blood pressure before administering this medication.
2. Risk for falls, Orthostatic Hypotension
3. Overdose produces HypOtension, Tachycardia, Headache, and generalized Skin Flushing.
4. Reflex Tachycardia because as the blood pressure declines, the** heart rate will increase** to maintain cardiac output.

Question 3

Selective Serotonin
(SSRIs)

Answer 3

Rapid Heartbeat

Muscle Twitches or Jerking

Seek Medical Attention right away

Question 4

Sevelamer

chronic kidney disease

Answer 4

Hyperphosphatemia-associated with chronic kidney disease and end-stage renal disease

These medication are only effective when taken with MEALS

Food sources with high levels of phosphorus include beans, fish, and nuts

Question 5

Aspart insulin
rapid actin insulin

The three rapid-acting insulins are lispro, aspart, and glulisine

Answer 5

no greater than 10-15 minutes prior to the meal

Question 6

Glargine

Answer 6

** No peak effect**

Insulin glargine is a long-acting insulin that provides basal control of

Question 7

Tolvaptan
vasopressin

Answer 7

causes the excretion of free water, which raises sodium levels

The client’s sodium needs to be monitored, this medication because it may cause hypernatremia

This medication is very hepatotoxic- liver function tests should be monitored closely

This urine-specific gravity is normal (1.005 - 1.025)

Question 8

SIADH

Answer 8

Polydipsia
Hemodilution
Oliguria

Question 9

Quetiapine
antipsychotic

Answer 9

Fever

Stooped Posture

Shuffling Gait

extrapyramidal syndrome (EPS). Report to the primary healthcare provider

Question 10

** Quetiapine**

atypical antipsychotic

Answer 10

Quetiapine is an atypical antipsychotic used in the management of bipolar and schizophrenia. Adversely, antipsychotics may cause Neuroleptic Malignant Syndrome (NMS), which is manifested by fever, muscle rigidity, and tachycardia. Additionally, antipsychotics may cause extrapyramidal side effects, including dystonia, akathisia, or pseudo parkinsonism such as stooped posture, bradykinesia, and shuffling gait

Question 11

Warfarin

Answer 11

** Avoid**
Spinach
Kale

Question 12

Patients with which of the following medical history would be contraindication to take warfarin?

Answer 12

History of hemorrhagic stroke is a contraindication for taking warfarin

Question 13

Narcotics and controlled substances

Answer 13

Waste at the time of removal from the storage

Witnessing nurses must watch the administering nurse as the correct dose is drawn

Witnessing nurses must observe as the unneeded portion is wasted in the approved manner

Document the waste electronically or in writing

The witness to the wasting of controlled substances should verify the product label, the number of wasted matches what is documented, and that the medication is wasted in an irretrievable location

Two nurses, both the administering nurse and the witness, are responsible for documenting the wastage. Either a registered nurse or a licensed practical nurse can witness and sign. A nurse should never document seeing controlled substance wastage that was not observed

Question 14

Doxycycline

Answer 14

Tetracycline antibiotics are contraindicated if the client is pregnant

Doxycycline is an effective antibiotic utilized in PID

Question 15

Methotrexate and Hydroxychloroquine

Answer 15

**pancytopenia **(low red blood cells, white blood cells, and platelets)

Folic acid deficiency is common while a client is taking the medication
Increase the intake of folic acid-rich foods and supplemental folic acid

Question 16

Epoetin alfa

Answer 16

Increase red blood cell production for those with chronic kidney disease

therapeutic effect of increasing hemoglobin and hematocrit

Uncontrolled** hypertension is a contraindication** to this medication.

Epoetin alfa is an effective treatment for anemia secondary to chronic kidney disease. This medication is given parenterally, and the nurse should expect a therapeutic response of an increase in hemoglobin and hematocrit.

Once the hemoglobin gets to 11 g/dl, the nurse should question further administration as higher hemoglobin levels have been implicated with causing myocardial infarction or stroke.

The priority vital sign to monitor during the course of therapy is blood pressure.

Question 17

Furosemide

Answer 17

The earlier part of the day to avoid nocturia

This medication causes wasting of sodium, potassium, calcium, and magnesium. Prior to administering furosemide, the nurse should assess these electrolytes as well as the patient’s blood pressure.

Question 18

Anticholinergic medications

Answer 18

Worsen patients’ condition with glaucoma
Anticholinergic agents also can produce central side effects, such as confusion, unsteady gait, or drowsiness in adults.

Question 19

Warfarin

Answer 19

Can take several days to reach maximum effect. For this reason,

heparin and warfarin therapy are often overlapped

Question 20

Nitrous oxide

Answer 20

** dental procedures**

Nitrous oxide may be used for dental procedures or brief obstetrical or surgical procedures. It may also be used together with other general anesthetics, making it possible to decrease its dosage with greater effectiveness. There are two primary methods of causing general anesthesia. IV agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia.

Question 21

NGT

Answer 21

✓ After the placement of an NGT, the nurse should verify the placement via an x-ray

✓ Subsequent verification should come through gastric pH analysis. A pH < 4 indicates the tube is likely in the stomach.

✓ When administering medications via NGT, the nurse should never crush extended-release or sustained-release medications.

✓ To administer medications via NGT, the nurse should disconnect the NGT suctioning.

✓ The nurse should initially flush the NGT with 20-30 mL of tepid tap water.

✓ The nurse should flush the tube with 15 mL between each medication.

✓ Once the medications have been administered, the nurse should flush the NGT with 20-30 mL of tepid tap water.

✓ The Levin and Salem sump tubes are the most common for stomach decompression.

✓ The Levin tube is a single-lumen tube with holes near the tip

✓ The Salem sump tube is preferable for stomach decompression. The tube has two lumina: one for removal of gastric contents and one to provide an air vent.

Question 22

Rights of Medication Administration

Answer 22

Timely medication reconciliation is fundamental in the prevention of medication errors.

Medication reconciliation is when the client’s medications are inventoried and assessed for interactions, duplications, or omissions.

Completing a medication reconciliation at admission, a transition of care, and discharge will identify potentially dangerous drug-to-drug interactions.

Verbal and telephone errors are significant sources of medication errors.

The nurse should limit these types of orders to emergent situations.

These methods are discouraged because accents, dialects, and drug name pronunciations may skew the order being given.

Question 23

Enoxaparin

Answer 23

low molecular weight-based heparin (LMWH) indicated for VTE prophylaxis following surgery. This medication is only given subcutaneously in the abdomen.

Question 24

Enoxaparin

Answer 24

Enoxaparin is a type of LMWH. This medication may be used prophylactically for a VTE or to treat an existing VTE.

➢ This medication does not require aPTT monitoring, unlike heparin.

➢ Monitoring for platelet-induced thrombocytopenia is essential while the patient is taking this medication.

➢ Recent spinal surgery, an epidural, or peptic ulcer disease all require clarification of the prescription with the prescriber.

➢ The medication is given subcutaneously only in the abdomen. The nurse should not rub the injection site after administration.

➢ Enoxaparin comes in a prefilled syringe and has a bubble. The nurse should not push out the bubble as this will cause some medication to be wasted.

Question 25

Trazodone

Answer 25

This medication may cause priapism which is a prolonged, painful erection of the penis.

Trazodone is a serotonergic agent used frequently for the treatment of insomnia.

The nurse must implement fall precautions with this medication because sedation and dizziness are likely to occur. Adversely, this medication has caused priapism in males. This condition causes a painful, persistent erection that requires emergent medical care.

Question 26

** priapism**

Answer 26

a prolonged erection of the penis

Question 27

Atenolol

Answer 27

The nurse should assess both before administration

Question 28

Spironolactone

Answer 28

This medication decreases fluid volume, therefore, reducing blood pressure

Question 29

Fentanyl

Answer 29

The nurse should monitor the client’s blood pressure and respiratory rate before and after administration

Question 30

Enoxaparin

Answer 30

The bubble should not be expelled before administration

Injected at either a** 90 or 45-degree angle**
Administered subcutaneously

Does not require monitoring the activated partial thromboplastin time (aPTT)

Monitor the client for bleeding as well as heparin-induced thrombocytopenia (HIT)

The antidote for enoxaparin is protamine sulfate

Question 31

Regular insulin

Answer 31

Intravenously is prescribed to correct the acidosis and hyperkalemia.

During the infusion of regular insulin, the client should be monitored for hypoglycemia and hypokalemia

Regular insulin is the only insulin that may be administered intravenously

Question 32

Clozapine

antipsychotic

reserved for those who have not responded to other agents

Answer 32

May cause significanweight gain and hypersalivation. The client should be instructed to watch their calorie intake and exercise with appropriate hydration

This medication treats schizophrenia and mood disorders that may cause significant aggression or violence

This medication carries serious effects, including agranulocytosis, myocarditis, sialorrhea, and weight gain

The client will require frequent laboratory work to** monitor their neutrophil count**

Question 33

Pregabalin

Answer 33

Pregabalin is indicated in treating neuropathic pain, certain anxiety disorders, and focal seizures.

This controlled substance is five times more potent compared to gabapentin

Pregabalin is indicated for neuropathic pain and disorders causing neuropathic pain, such as fibromyalgia, herpes zoster, and phantom limb pain

This medication’s common side effects include dizziness, drowsiness, and respiratory depression when combined with other CNS depressants

Considering the CNS depressant effects of this medication, the nurse should institute fall precautions for the client.

Question 34

Buspirone

Answer 34

Buspirone is a medication indicated for anxiety disorders.

This medication modulates serotonin and does not have a sedative effect compared to benzodiazepines

The client should be educated to take this medication on time and to expect a response within** four to six weeks**

Buspirone has many drug-to-drug interactions, and completing a thorough inventory of the client’s current medications is essential.

Question 35

Administering Platelets

Answer 35

When administering platelets to a client, the nurse should ensure that completed consent from the client is obtained prior to transfusion.

Further, the nurse will obtain pre-transfusion vital signs
infuse platelets over 15-30 minutes

Question 36

Platelets are Infused

Answer 36

✓ The nurse will need to verify consent before transfusion and verify the blood product with another nurse before initiation.

✓ Platelets are infused over 15-30 minutes. Following the transfusion, the nurse should obtain post-transfusion vital signs.

✓ Platelets are not required to be ABO compatible; while compatibility is preferred, this is not always available.

✓ Clinically significant hemolytic transfusion reactions secondary to transfusion of ABO-incompatible platelet products (e.g., group O platelets given to group A client) are uncommon, but they do occur.

Question 37

0.9% saline

Answer 37

0.9% saline is an isotonic solution utilized in the treatment of standard dehydration

Question 38

** Doxorubicin**

Answer 38

Doxorubicin is highly cardiotoxic, which may cause cardiomyopathy

The cardiotoxicity may cause a decrease in left ventricular ejection fraction, therefore, causing pulmonary congestion and, at worse life-threatening pulmonary edema

The patient may present with leg edema, cough, and worsening shortness of breath

Question 39

Doxorubicin

Answer 39

may be indicated for a variety of cancers such as breast, ovarian, and bladder cancer.

Like many antineoplastics, this medication is a vesicant and should be administered only through a central line to avoid extravasation.

This antineoplastic is highly cardiotoxic, and initiating cardiac monitoring during the infusion is strongly recommended

Question 40

Doxorubicin

Answer 40

✓ Doxorubicin may be indicated for various cancers, such as breast, ovarian, and bladder cancer.

✓ Like many antineoplastics, this medication is a vesicant and should be administered only through a central line to avoid extravasation.

✓ This antineoplastic is highly cardiotoxic, and initiating cardiac monitoring during the infusion is strongly recommended.

Question 41

** Cimetidine**

Answer 41

Treating **peptic ulcer disease, gastric esophageal reflux disease, or H. pylori infections. **

This older medication has widely been replaced with newer H2 receptor antagonists because this medication is known to cause significant drowsiness

Question 42

Cimetidine and Famotidine

Answer 42

These medications work by blocking the H2 receptor of acid-producing parietal cells.

This makes the parietal cell less responsive to histamine and the stimulation of ACh and gastrin.

All of these medications are available over the counter (OTC)
Cimetidine has multiple drug-to-drug interactions

Cimetidine may cause drowsiness, and an increase in prolactin levels which may, in turn, cause gynecomastia and sexual dysfunction

Cimetidine may increase the** risk of falls**, especially in older adults

These drugs may be given in a single dose at bedtime to suppress nocturnal gastric acid secretion

These drugs should not be given concurrently with antacids

Question 43

Lorazepam

Answer 43

Used in the management of alcohol withdrawal symptoms

Question 44

Lorazepam

Answer 44

Alcohol withdrawal symptoms may manifest six hours after the last alcohol consumption. The withdrawal symptoms may worsen and cause the client to develop delirium tremens.

✓ Mild withdrawal signs and symptoms include irritability, anorexia, nausea, palpitations, and tachycardia.

✓ Moderate to severe signs and symptoms include clouded sensorium, tremors, hallucinations, unpredictable behavior, and agitation. The client may be at risk of having a seizure.

✓ Medication used in alcohol withdrawal includes benzodiazepines to suppress seizure activity and mitigate unpleasant withdrawal symptoms.

✓ Clonidine may be prescribed to mitigate the adrenergic signs (hypertension) and fluid repletion that may be supplemented with B-complex vitamins.

✓ Antipsychotics such as risperidone may be utilized to assist with residual delirium

Question 45

Risperidone, haloperidol, or fluphenazine

Answer 45

Schizophrenia is treated with antipsychotic medications. Typical (or first-generation) antipsychotic drugs include haloperidol, fluphenazine, and chlorpromazine.

A typical (second generation) antipsychotic medications include quetiapine, ziprasidone, and risperidone

Question 46

MAOIs

Answer 46

Foods high in tryptophan, tyramine, and caffeine, such as chocolate and cheese

cause dangerously high blood pressure when taken with certain foods or medications

Question 47

Intravenous heparin

Answer 47

Intravenous heparin is typically administered as a bolus dose first, then as a continuous infusion to achieve therapeutic aPTT.

A baseline aPTT should be collected 6 hours after the first dose and 6 hours following any dose adjustments.

The goal is to prolong the aPTT from 1.5 to 2.5 times the control value.

The normal aPTT value is 30-40.

Question 48

Enoxaparin

Answer 48

Enoxaparin is advantageous because this medication does not require PTT monitoring. This medication may be used in the treatment or prevention of venous thromboembolism. The nurse should inject enoxaparin into the patient’s abdomen.

Lab value-Platelet count

Question 49

Midazolam

Answer 49

Used for acute** anxiety attacks. **

Midazolam is preferred in this setting because of its rapid onset (2 to 5 minutes after IV administration) and short duration of action (3 to 8 hours). It can be administered intravenously or orally.

Given these benefits, midazolam would be the most useful for the patient experiencing an acute anxiety attack prior to/during endoscopic procedures or prior to surgery.

Additional benefits of midazolam during procedures are **sedation and amnesia. **

Midazolam as a continuous IV infusion is also used in sedating mechanically ventilated patients in critical care settings.

The nurse should keep flumazenil as an antidote ready in case severe respiratory depression occurs with benzodiazepines.

Question 50

Mirtazapine

Answer 50

✓ Mirtazapine is an agent used to treat depressive and anxiety disorders.

✓ This medication causes sedation and is dosed at night.

✓ This may be helpful for those with depressive disorders and who suffer from concomitant insomnia.

✓ Mirtazapine has the following side effects –

Increased Appetite
Weight gain
Sedation
Dizziness
Confusion

Question 51

suppression of bone marrow

Answer 51

Bruising or bleeding when taking antivirals could indicate possible bone marrow suppression which may require dosage adjustments or a medication change

Question 52

Fentanyl

Answer 52

✓ Fentanyl is an opioid that can be delivered in various preparations (intravenous, transdermal, buccal).

✓ The transdermal patch effectively provides a patient with continuous pain control for 72 hours.

✓ This medication will take 24 hours to reach its peak effect, and the nurse should anticipate the patient to experience breakthrough pain.

✓ Fentanyl patches should be applied to a clean area with minimal hair. Hair may be clipped but not shaven to ensure appropriate adhesion to the skin.

Question 53

Saw palmetto

Answer 53

➢ Saw palmetto is purported to treat benign prostatic hyperplasia and alopecia.

➢ Saw palmetto is believed to inhibit dihydrotestosterone and 5-alpha reductase

➢ This medication should be used with the prescriber’s approval if the client is taking anticoagulants or medications for erectile dysfunction, as the medication may potentiate the anticoagulant effects

Question 54

Cisplatin

Answer 54

** Bone marrow suppression** is the most significant adverse reaction of this particular class of drugs

Blood cells are susceptible to alkylating agents and bone marrow suppression is the most important adverse effect of this class. Within days after administration, the numbers of red blood cells, white blood cells, and platelets begin to decline.

Question 55

Aspirin overdose

Answer 55

Early symptoms of aspirin poisoning include tinnitus, hyperventilation, vomiting, dehydration, and fever.

Late signs include drowsiness, unsteady gait, bizarre behavior, and coma.

Abnormal breathing caused by aspirin overdose is usually deep and rapid.

Pulmonary edema may be related to an increase in the lung capillaries’ permeability, leading to “protein leakage” and transudation of fluid in both renal and pulmonary tissues.

The alteration in renal tubule permeability may lead to a change in colloid osmotic pressure, facilitating pulmonary edema

Question 56

Sertraline

Answer 56

This medication is efficacious in depression, anxiety, and obsessive-compulsive disorders

Sertraline being serotonergic, requires time to become efficacious.

Two to four weeks is usually required for the patient to achieve a response.

The nurse should counsel the patient to report worsening of their mood and any suicidal ideations.

Gastrointestinal side effects are common with SSRIs and may decrease by taking the medication with food.

Question 57

Management of Atrial Fibrillation

Answer 57

** Diltiazem**

an anticoagulant such as** warfarin** or rivaroxaban is used in the management of atrial fibrillation as this arrhythmia puts the patient at high risk for a stroke

The primary goal for a patient with atrial fibrillation is to maintain rate control (60-100). Medications such as diltiazem, digoxin, amiodarone, and dronedarone may be utilized.

Anticoagulants are also indicated as ischemic strokes are commonly associated with atrial fibrillation.

Question 58

Citalopram
antidepressant

Answer 58

This selective serotonin reuptake inhibitor (SSRI) is prescribed for depressive and anxiety disorders.

If a client has depression, one of the associated manifestations is decreased self-esteem/self-worth.

This may cause clients to reduce their ability to engage with others and become socially withdrawn

✓ The SSRI medication class includes citalopram, escitalopram, fluvoxamine, fluoxetine, sertraline, and paroxetine.

✓ These medications treat generalized anxiety disorder and major depressive disorder.

✓ It takes approximately four to six weeks for these medications to establish efficacy.

✓ The nurse should monitor the client for suicidal behavior or an abrupt mood shift which may indicate the development of mania.

Question 59

lispro, aspart, glulisine

Answer 59

✓ The three rapid-acting insulins are lispro, aspart, and glulisine.

✓ The client needs to take this insulin 10-15 minutes before a meal or while actively eating.

✓ A rapid-acting insulin is utilized as correctional insulin before meals to prevent post-prandial hyperglycemia.

✓ This type of insulin is commonly loaded into an insulin pump

Question 60

Peritonitis
ciprofloxacin, metronidazole, or ceftriaxone

Answer 60

Clinical manifestations of peritonitis include

✓ Rigid, board-like abdomen

✓ Distended abdomen

✓ High fever

✓ Tachycardia

✓ Diffuse abdominal pain that continues to intensify

✓ Decreased bowel sounds and GI motility

Question 61

Intramuscular sites

Answer 61

✓ For adults, potential intramuscular sites include the ventrogluteal, vastus lateralis, and deltoid.

✓ The dorsogluteal site is not recommended because of potential damage to nearby nerves and blood vessels.

✓ A normal, well-developed adult patient tolerates 3 mL of medication into a larger muscle without severe muscle discomfort.

✓ Larger volumes of medication (4–5 mL) are unlikely to be absorbed properly.

✓ Children, older adults, and clients who are thin tolerate only 2 mL of an IM injection.

✓ Do not give more than 1 mL to small children and older infants, and do not give more than 0.5 mL to smaller infants

Question 62

Flumazenil

Answer 62

Flumazenil is the antidote for benzodiazepine overdose. Lorazepam is a benzodiazepine, so the nurse expects to administer this medication to the client.

Question 63

Digoxin

Answer 63

Digoxin is a cardiac glycoside indicated for the treatment of atrial fibrillation and congestive heart failure (CHF).

This medication has lost popularity in recent decades because newer agents do not require therapeutic monitoring.

For a client taking digoxin, the apical pulse needs to be obtained prior to administration.

The apical pulse needs to be at least 60/minute for adults; 70/minute for children; 90 for infants.

Question 64

Isotretinoin

Answer 64

approved for the treatment of moderate to severe acne vulgaris.

Question 65

Lidocaine

Answer 65

An antiarrhythmic utilized in the treatment and prevention of ventricular arrhythmias.

A similar drug to lidocaine is amiodarone.

Question 66

Methotrexate (MTX)

Answer 66

This medication carries serious adverse effects such as pancytopenia (low red blood cells, white blood cells, and platelets)

Thus, this may cause a client to bruise more easily and be at a higher risk of infection. MTX antagonizes folic acid, and while a client is taking MTX, folic acid supplementation is typically prescribed

✓ MTX is a medication approved for the treatment of a variety of conditions, including Rheumatoid Arthritis.

✓ This medication may also be prescribed for clients with ectopic pregnancy (EP) that has not ruptured.

✓ An array of adverse effects may occur at low- and high doses. These include blood dyscrasias, stomatitis, and pulmonary toxicity.