summer exam 1 Flashcards
a nurse knows which neurotransmitters are involved in Parkinson’s disease?
dopamine and acetylcholine
dopamine
-inhibitory neurotransmitter
-helps control muscle movement, rewards, and motivation
acetylcholine
-excitatory neurotransmitter
-enhances senses, stimulates muscle movement, and sustains attention
side effects of carbidopa/levodopa
excess peripheral dopamine= dysrhythmia/palpitations, orthostatic hypotension, involuntary movements, hallucinations, GI distress
classification of Benztropine
anticholinergic
Benztropine’s classification causes the side effect of. . .
dry up - drowsiness, constipation, urinary retention, dry mouth
how would a nurse educate the client to combat the side effects they might experience from benztropine?
- 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)
what should a nurse educate the client to do before taking an anticholinergic medication?
- 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
muscle relaxers cause what major side effect? ___________________.
sedation
what nursing considerations would be a priority to address as a nurse caring for a client newly prescribed Cyclobenzaprine?
- avoid activities that require alertness
- other CNS depressants will increase sedation
- taper off to d/c
what are the properties of acetylsalicylic acid?
antipyretic, anti-inflammatory & analgesic, antiplatelet aggregate
when would a nurse not want to give acetylsalicylic acid to her adult client?
when the child has a viral infection, which could pose as a risk for Reye’s Syndrome
what assessment finding would a nurse observe with toxicity to acetylsalicylic acid in an adult?
tinnitus, hearing loss
what assessment finding would a nurse observe with toxicity to acetylsalicylic acid in a child?
behavioral changes, dizziness, drowsiness, hypoventilation
why should infants not receive acetylsalicylic acid?
Reye’s Syndrome
NSAIDS target prostaglandins synthesis. If we stop prostaglandins synthesis the patient will experience a decrease in ___________________.
inflammation
prostaglandins protects what in the body? ______________. Therefore, what nursing interventions are needed for a client on this medication?
Ibuprofen and acetylsalicylic acid are both ___________ (classification).
NSAIDS
what are the 4 properties of these medications?
analgesic, anti-inflammatory, antipyretic, antiplatelet aggregate
a priority assessment for adverse effect a nurse should be making while a client is on any NSAID is __________.
bleeding? (black, tarry stool)
where would the nurse most likely see this complication manifest?
in the stool
a nurse knows that a client with osteoarthritis benefits from taking Celecoxib due the decrease in ____________ ________.
COX-2 (anti-inflammatory)
but the nurse would consider an allergy to ___________ and any history of ________ _________ when planning the client’s medication administration.
sulfa, cardiac disease or stroke
a client comes into the clinic with a suspected infection. What risk factors place the client at risk for infection?
- infants
- high stress
- malnourishment/underweight
- immunocompromised
- HIV/AIDs, cancer, autoimmune pts on meds
- elderly
what are the 2 different actions of antibiotics? (How do they work?)
- bactericidal: kills bacteria
- bacteriostatic: inhibits/slows growth of bacteria, eventually leading to bacterial death
what would a nurse teach clients to prevent bacterial resistance to antibiotics?
finish taking all prescribed antibiotics, even if feeling better
what is an early sign of adverse effect of antibiotics?
pruritus, urticaria
antibiotics are great to treat bacterial infections but they are dumb. -What does Dr. Snider mean when she says this?
since antibiotics are dumb, how would you intervene if a client began having loose stools? (What would be your priority?)
an elderly client is prescribed nitrofurantoin long term. The nurse understands this is for _____ ___________.
UTI prophylaxis
a nurse knows that sulfonamides are primarily used to treat what type of infections?
UTI, otitis media (bacterial)
what would a nurse teach clients about hydration while on antibiotics?
hydration enhances antibiotic absorption
when reading an order for the medication trimethoprim/ sulfamethoxone the nurse understands this is a ____________ drug most commonly used to treat ____________.
sulfa, UTIs
Tetracycline has a strong affinity for _________. Therefore should not be used in children because of ______________ ______________.
- calcium
- teeth staining
a major adverse effect of fluoroquinolones is _____________ _____________. A nurse knows that due to this the medication would be held when ____________________________.
-tendonitis rupture
- . . .the pt reports tendon pain and inflammation is observed
aminoglycosides cause what toxicities?
nephro, oto, neuro
what are the s/s of each aminoglycoside toxicity?
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
what is the advantage to being prescribed azithromycin?
- only side effect is GI upset, which can be prevented by administering with food
- bacteriostatic
many antibiotics cause photosensitivity. Which ones did we discuss that causes this?
sulfonamides (trimethoprim/sulfamethoxazole (Bactrim))
how would a nurse know a client has adequate pain control (besides using the pain scale). What would the nurse observe?
- facial expression
- mood
- position
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 ____________________________________.
administer narcan?
other side effects of an opioid the nurse should monitor for are. . .
- elevated temp
- shallow respirations
- agitation
- decreased LOC
- hyperglycemia
- poor sleep
what would a nurse teach a breast-feeding client about opioid use?
must wait 4-6 hours after opioid intake
what 2 priority assessments would a nurse want to perform with a client on with a PCA?
- pain level
- respiratory status
what organ does acetaminophen adversely affect?
liver
what labs would tell you there is an adverse effect from acetaminophen?
- AST/ALT
what is the reversal agent for Opioids?
naloxone (narcan)
how does the reversal agent work?
binds to opioid pain receptor and blocks the effect of agonist
what a nurse should expect when giving the reversal agent?
- onset is 1-2 min, wears off in 30 min-2 hr
what should a client on immunosuppression avoid?
exposure to crowds
what are the 4 main adverse effects of Steroids?
- GI upset
- osteoporosis (long-term use)
- hyperglycemia
- weight gain
- mood changes (“roid rage”)
what can happen if you d/c steroids abruptly?
may lead to shock
Adalimumab (humira) works by causing __________________________. This places the client at high risk for ______________.
immunosuppression; infection
how would a nurse expect to administer Adalimumab?
40mg every other week, may advance to 40mg weekly if indicated (Sub-Q)
Methotrexate can suppress _________ ____________.
bone marrow
what is the priority assessment with the suppression found with Methotrexate?
- pallor
- heart rate (tachycardia)
- observing how tired the pt becomes upon minimal exertion
Methotrexate can cause __________ and ___________ damage.
renal and liver damage
which labs would the nurse monitor for the damage caused by Methotrexate consumption?
CBC, platelets, BUN/Creatinine, ALT/AST
a client taking Hydroxychloroquine should be educated to report what adverse effect immediately?
vision changes (retinopathy)
gold salts are used for ____________________ of arthritis.
treatment
Auranofin is given ________ ___________ and can cause __________ _________ suppression and toxicity to the ___________.
long-term, bone marrow, kidneys
what is the most common adverse effect of any anticoagulant?
bleeding
how (what) should clients be educated to decrease the risk of the most common adverse effect of anticoagulation?
- 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
Heparin therapeutically is an anticoagulant. Explain how it works pharmacologically.
accelerates formation of antithrombin III-thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin
inhibits new clots from forming
how does alteplase work pharmacologically?
converts plasminogen to plasmin by directly cleaving peptide bonds at two sites, causing fibrinolysis
dissolves clot
what lab values should be monitored with the administration of heparin?
- platelets
- aPTT (60-80 seconds)
- PPT (120-140 seconds)
what lab values should be monitored with the administration of lovenox?
- platelets
- PT/INR
some drugs have interactions with certain foods. Which anticoagulants have interactions and to which foods?
- 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)
what role does aspirin play in bleeding? (how does it work?)
prevents clot formation by inhibiting cox1&2, which prevents the production of thromboxane A (2)
what lab should be monitored when administering aspirin in regards to bleeding?
aPTT, PT/INR
