summer exam 1

Question 1

a nurse knows which neurotransmitters are involved in Parkinson’s disease?

Answer 1

dopamine and acetylcholine

Question 2

dopamine

Answer 2

-inhibitory neurotransmitter
-helps control muscle movement, rewards, and motivation

Question 3

acetylcholine

Answer 3

-excitatory neurotransmitter
-enhances senses, stimulates muscle movement, and sustains attention

Question 4

side effects of carbidopa/levodopa

Answer 4

excess peripheral dopamine= dysrhythmia/palpitations, orthostatic hypotension, involuntary movements, hallucinations, GI distress

Question 5

classification of Benztropine

Answer 5

anticholinergic

Question 6

Benztropine’s classification causes the side effect of. . .

Answer 6

dry up - drowsiness, constipation, urinary retention, dry mouth

Question 7

how would a nurse educate the client to combat the side effects they might experience from benztropine?

Answer 7

• chew on sugar-free gum or candy to combat dry mouth
• report urinary retention and constipation
• increase fluids
• do not participate in activities where falling may take place (use caution and/or assistive devices)

Question 8

what should a nurse educate the client to do before taking an anticholinergic medication?

Answer 8

• increases fall risk
• do not take if you have a GI/GU obstruction
• increase fluids
• have sugar-free gum or candy to treat dry mouth
• report constipation and urinary retention

Question 9

muscle relaxers cause what major side effect? ___________________.

Answer 9

sedation

Question 10

what nursing considerations would be a priority to address as a nurse caring for a client newly prescribed Cyclobenzaprine?

Answer 10

• avoid activities that require alertness
• other CNS depressants will increase sedation
• taper off to d/c

Question 11

what are the properties of acetylsalicylic acid?

Answer 11

antipyretic, anti-inflammatory & analgesic, antiplatelet aggregate

Question 12

when would a nurse not want to give acetylsalicylic acid to her adult client?

Answer 12

when the child has a viral infection, which could pose as a risk for Reye’s Syndrome

Question 13

what assessment finding would a nurse observe with toxicity to acetylsalicylic acid in an adult?

Answer 13

tinnitus, hearing loss

Question 14

what assessment finding would a nurse observe with toxicity to acetylsalicylic acid in a child?

Answer 14

behavioral changes, dizziness, drowsiness, hypoventilation

Question 15

why should infants not receive acetylsalicylic acid?

Answer 15

Reye’s Syndrome

Question 16

NSAIDS target prostaglandins synthesis. If we stop prostaglandins synthesis the patient will experience a decrease in ___________________.

Answer 16

inflammation

Question 17

prostaglandins protects what in the body? ______________. Therefore, what nursing interventions are needed for a client on this medication?

Question 18

Ibuprofen and acetylsalicylic acid are both ___________ (classification).

Answer 18

NSAIDS

Question 19

what are the 4 properties of these medications?

Answer 19

analgesic, anti-inflammatory, antipyretic, antiplatelet aggregate

Question 20

a priority assessment for adverse effect a nurse should be making while a client is on any NSAID is __________.

Answer 20

bleeding? (black, tarry stool)

Question 21

where would the nurse most likely see this complication manifest?

Answer 21

in the stool

Question 22

a nurse knows that a client with osteoarthritis benefits from taking Celecoxib due the decrease in ____________ ________.

Answer 22

COX-2 (anti-inflammatory)

Question 23

but the nurse would consider an allergy to ___________ and any history of ________ _________ when planning the client’s medication administration.

Answer 23

sulfa, cardiac disease or stroke

Question 24

a client comes into the clinic with a suspected infection. What risk factors place the client at risk for infection?

Answer 24

• infants
• high stress
• malnourishment/underweight
• immunocompromised
• HIV/AIDs, cancer, autoimmune pts on meds
• elderly

Question 25

what are the 2 different actions of antibiotics? (How do they work?)

Answer 25

- bactericidal: kills bacteria - bacteriostatic: inhibits/slows growth of bacteria, eventually leading to bacterial death

Question 26

what would a nurse teach clients to prevent bacterial resistance to antibiotics?

Answer 26

finish taking all prescribed antibiotics, even if feeling better

Question 27

what is an early sign of adverse effect of antibiotics?

Answer 27

pruritus, urticaria

Question 28

antibiotics are great to treat bacterial infections but they are dumb. -What does Dr. Snider mean when she says this?

Question 29

since antibiotics are dumb, how would you intervene if a client began having loose stools? (What would be your priority?)

Question 30

an elderly client is prescribed nitrofurantoin long term. The nurse understands this is for _____ ___________.

Answer 30

UTI prophylaxis

Question 31

a nurse knows that sulfonamides are primarily used to treat what type of infections?

Answer 31

UTI, otitis media (bacterial)

Question 32

what would a nurse teach clients about hydration while on antibiotics?

Answer 32

hydration enhances antibiotic absorption

Question 33

when reading an order for the medication trimethoprim/ sulfamethoxone the nurse understands this is a ____________ drug most commonly used to treat ____________.

Answer 33

sulfa, UTIs

Question 34

Tetracycline has a strong affinity for _________. Therefore should not be used in children because of ______________ ______________.

Answer 34

- calcium - teeth staining

Question 35

a major adverse effect of fluoroquinolones is _____________ _____________. A nurse knows that due to this the medication would be held when ____________________________.

Answer 35

-tendonitis rupture - . . .the pt reports tendon pain and inflammation is observed

Question 36

aminoglycosides cause what toxicities?

Answer 36

nephro, oto, neuro

Question 37

what are the s/s of each aminoglycoside toxicity?

Answer 37

nephro- hematuria, proteinuria, increased BUN/Creatinine, decreased urinary output oto- tinnitus, dizziness/vertigo, partial hearing loss (may be permanent) neuro- numbness, tremors, tingling, twitching, weakness, paralysis

Question 38

what is the advantage to being prescribed azithromycin?

Answer 38

- only side effect is GI upset, which can be prevented by administering with food - bacteriostatic

Question 39

many antibiotics cause photosensitivity. Which ones did we discuss that causes this?

Answer 39

sulfonamides (trimethoprim/sulfamethoxazole (Bactrim))

Question 40

how would a nurse know a client has adequate pain control (besides using the pain scale). What would the nurse observe?

Answer 40

- facial expression - mood - position

Question 41

a client has just returned from surgery and has requested a dose of an opioid. A nurse knows to combat respiratory issues the nurse should educate the client to ____________________________________.

Answer 41

administer narcan?

Question 42

other side effects of an opioid the nurse should monitor for are. . .

Answer 42

- elevated temp - shallow respirations - agitation - decreased LOC - hyperglycemia - poor sleep

Question 43

what would a nurse teach a breast-feeding client about opioid use?

Answer 43

must wait 4-6 hours after opioid intake

Question 44

what 2 priority assessments would a nurse want to perform with a client on with a PCA?

Answer 44

- pain level - respiratory status

Question 45

what organ does acetaminophen adversely affect?

Answer 45

liver

Question 46

what labs would tell you there is an adverse effect from acetaminophen?

Answer 46

- AST/ALT

Question 47

what is the reversal agent for Opioids?

Answer 47

naloxone (narcan)

Question 48

how does the reversal agent work?

Answer 48

binds to opioid pain receptor and blocks the effect of agonist

Question 49

what a nurse should expect when giving the reversal agent?

Answer 49

- onset is 1-2 min, wears off in 30 min-2 hr

Question 50

what should a client on immunosuppression avoid?

Answer 50

exposure to crowds

Question 51

what are the 4 main adverse effects of Steroids?

Answer 51

- GI upset - osteoporosis (long-term use) - hyperglycemia - weight gain - mood changes ("roid rage")

Question 52

what can happen if you d/c steroids abruptly?

Answer 52

may lead to shock

Question 53

Adalimumab (humira) works by causing __________________________. This places the client at high risk for ______________.

Answer 53

immunosuppression; infection

Question 54

how would a nurse expect to administer Adalimumab?

Answer 54

40mg every other week, may advance to 40mg weekly if indicated (Sub-Q)

Question 55

Methotrexate can suppress _________ ____________.

Answer 55

bone marrow

Question 56

what is the priority assessment with the suppression found with Methotrexate?

Answer 56

- pallor - heart rate (tachycardia) - observing how tired the pt becomes upon minimal exertion

Question 57

Methotrexate can cause __________ and ___________ damage.

Answer 57

renal and liver damage

Question 58

which labs would the nurse monitor for the damage caused by Methotrexate consumption?

Answer 58

CBC, platelets, BUN/Creatinine, ALT/AST

Question 59

a client taking Hydroxychloroquine should be educated to report what adverse effect immediately?

Answer 59

vision changes (retinopathy)

Question 60

gold salts are used for ____________________ of arthritis.

Answer 60

treatment

Question 61

Auranofin is given ________ ___________ and can cause __________ _________ suppression and toxicity to the ___________.

Answer 61

long-term, bone marrow, kidneys

Question 62

what is the most common adverse effect of any anticoagulant?

Answer 62

bleeding

Question 63

how (what) should clients be educated to decrease the risk of the most common adverse effect of anticoagulation?

Answer 63

- do not use razors - use soft toothbrush - avoid potentially dangerous activities that can cause injury - avoid alcohol - provide pressure to injection site if bleeding begins

Question 64

Heparin therapeutically is an anticoagulant. Explain how it works pharmacologically.

Answer 64

accelerates formation of antithrombin III-thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin *inhibits new clots from forming*

Question 65

how does alteplase work pharmacologically?

Answer 65

converts plasminogen to plasmin by directly cleaving peptide bonds at two sites, causing fibrinolysis *dissolves clot*

Question 66

what lab values should be monitored with the administration of heparin?

Answer 66

- platelets - aPTT (60-80 seconds) - PPT (120-140 seconds)

Question 67

what lab values should be monitored with the administration of lovenox?

Answer 67

- platelets - PT/INR

Question 68

some drugs have interactions with certain foods. Which anticoagulants have interactions and to which foods?

Answer 68

- warfarin: foods with vitamin K (eat consistently or limit to. keep PT/INR consistent) - apixaban (Eliquis): grapefruit juice (may increase drug level and risk of bleeding) - clopidogrel (Plavix): grapefruit, grapefruit juice (may reduce drug's antiplatelet effects)

Question 69

what role does aspirin play in bleeding? (how does it work?)

Answer 69

prevents clot formation by inhibiting cox1&2, which prevents the production of thromboxane A (2)

Question 70

what lab should be monitored when administering aspirin in regards to bleeding?

Answer 70

aPTT, PT/INR