Uworld Pharmacology

Question 1

alteplase

Answer 1

Thrombolytic agent

• are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
• They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
• contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage

Question 2

Trimethoprim-sulfamethoxae

Answer 2

(Bactrim) is a sulfonamide antibiotic, commonly referred to as a sulfa drug.

• These antibiotics are prescribed to treat bacterial infections (eg, urinary tract infections).
• Contraindications include hypersensitivity to sulfa drugs, and pregnancy or breastfeeding.

Question 3

Glyburide

Answer 3

used to treat diabetes mellitus, and it can cause significantly low blood sugar if ingested by a client who does not have diabetes

• is a sulfonylurea and has the potential to cause a sulfa cross-sensitivity reaction.
• The major adverse effects of sulfonylurea medications are hypoglycemia and weight gain.
• Clients should be taught to use sunscreen and protective clothing as serious sunburns can occur.
• Clients should avoid alcohol as it lowers blood glucose and can lead to severe hypoglycemia.
• carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin)

Question 4

Common diuretics that can cause sulfa allergies

Answer 4

thiazides, furosemide are sulfa derivatives and can cause cross-sensitivity reaction.

Question 5

Crystalluria is a potential adverse effect

Answer 5

of sulfa medications.

- Clients should drink at least 2-3 L of water daily to prevent crystalluria.

Question 6

What foods decrease the effects of warfarin

Answer 6

Warfarin - works by inhibiting vitamin K-dependent clotting factors

• Consumption of foods rich in vitamin K will decreases the effectiveness of warfarin
• clients must be taught to eat the same amount of or avoid dark, green, leafy vegetables.

Clients are not instructed to remove those foods from their diet but are encouraged to be consistent in the intake of foods high in vitamin K, including leafy green vegetables, asparagus, broccoli, kale, Brussels sprout, and spinach.

Several beverages also affect warfarin therapy. Green tea, grapefruit juice, and cranberry juice may alter its anticoagulant effects.

Question 7

nifedipine

Answer 7

• Peripherally acting calcium channel block
• used to treat hypertension and do not worsen bronchoconstriction
• cause vasodilation, and clients may develop peripheral edema
• — This is an expected, frequent side effect and is not an allergic reaction.
• – Clients are advised to elevate the legs when lying down and to use stockings.
• also used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.
• avoid grapefruit juice!! - cause severe hypotension

Question 8

The following should be taught to clients taking tetracyclines (eg, tetracycline, doxycycline, minocycline):

Answer 8

• Take on an empty stomach – for optimum absorption, tetracyclines should be taken 1 hour before or 2 hours after meals
• Avoid antacids or dairy products – tetracyclines should not be taken with iron supplements, antacids, or dairy products as they bind with the drug and decrease its absorption
• Take with a full glass of water – tetracyclines can cause pill-induced esophagitis and gastritis; the risk can be reduced by taking with a full glass of water and remaining upright after pill ingestion
• Photosensitivity – severe sunburn can occur with tetracycline. The client should use sunblock
• Medications such as tetracycline and rifampin can decrease the effectiveness of oral contraceptives; additional contraceptive techniques will be needed

Question 9

Drug of choice to treat SVT

Answer 9

Adenosine is the drug of choice to treat SVT and has a 5- to 6-second half-life (the time it takes for the drug to be reduced to half of its original concentration).

• Placing the IV line as close as possible, not distal, to the heart is essential for the drug to have full effect.
• Adenosine is given rapidly over 1-2 seconds and then followed by a rapid 20-mL normal saline flush.
• Transient asystole is common, and clients often experience flushing and dizziness.
• Repeat boluses of 12 mg may be given twice if the rapid rhythm persists

Question 10

benztropine

Answer 10

(Cogentin) - Anticholinergic

• used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide.
• given for tremors for parkinsons
• Give IV for a dystonic reaction –Severe neck spasms in an individual taking haloperidol (and other psychotropic medications)
• a common side effect is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat
• in clients with benign prostatic hyperplasia or glaucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode

Question 11

radioactive iodine (RAI)

Answer 11

• the primary treatment for nonpregnant adults with hyperthyroid disorders such as Graves’ disease (a type of autoimmune hyperthyroid disease).
• RAI damages or destroys the thyroid tissue, thereby limiting thyroid secretion, and can result in hypothyroidism. Clients need to take thyroid supplementation (levothyroxine) for life.
• The use of RAI is contraindicated in pregnancy and could cause harm to a fetus. Pregnancy results should therefore be confirmed using a valid pregnancy test in all clients who still have menstrual cycles rather than using a subjective form of assessment such as asking when the last menstrual period occurred
• Radiation thyroiditis and parotitis, which cause dryness and irritation to the mouth, may occur after RAI treatment.
• -The nurse can teach the client to take sips of water frequently or to use a salt and soda gargle solution 3-4 times daily to relieve these symptoms.

Question 12

levothyroxine

Answer 12

• thyroid replacement supplement for hypothyroidism
• used to replace thyroid hormone in clients with hypothyroidism (inadequate thyroid hormone) and for those who have had their thyroid removed.
• These clients must understand that this medication must be taken for the rest of their lives
• A client’s dose is adjusted based on serum TSH levels to prevent too much or too little hormone. Clients must be taught to report signs of excess thyroid hormone such as heart palpitations/tachycardia, weight loss, and insomnia
• safe to take during pregnancy
• best to take this medication first thing in the morning as it is best absorbed on an empty stomach (1 hour before or 2 hours after a meal)

Several medications impair the absorption of levothyroxine (Synthroid). Common offenders are antacids, calcium, and iron preparations. Some of these could be present in several over-the-counter multivitamin and mineral tablets. Therefore, clients with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications.

The client’s therapeutic response to levothyroxine (Synthroid) is evaluated by resolution of hypothyroidism symptoms. The expected response includes improved well-being with elevated mood, higher energy levels, and a heart rate that is within normal limits. The nurse should consult the health care provider if the heart rate is >100/min, or if the client reports chest pain, nervousness, or tremors; this may indicate that the dose is higher than necessary. Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8 weeks after initiation to see the full therapeutic effect

Question 13

alprazolam =

Answer 13

Xanax - Benzodiazepine

• commonly used antianxiety drugs.
• work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
• may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
• never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.

Question 14

clonazepam

Answer 14

Benzodiazepines - commonly used antianxiety drugs.

• work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
• may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
• never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.

Question 15

lorazepam =

Answer 15

Ativan - Benzodiazepine

• commonly used antianxiety drugs.
• considered standard treatment to control agitation in the client in alcohol withdrawal
• work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
• may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
• never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
• has a long half-life (10-17 hours). Side effects include drowsiness, dizziness, ataxia, and confusion
• IV used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic

Question 16

Eliminating aged cheeses and processed meats is necessary with?

Answer 16

monoamine oxidase inhibitors (eg, tranylcypromine, phenelzine), which are used for depressive disorders.

aged cheeses and processed meats contain tyramine

Question 17

tranylcypromine

Answer 17

monoamine oxidase inhibitor - used for depressive disorders.

Question 18

phenelzine

Answer 18

(Nardil) monoamine oxidase inhibitor - used for depressive disorders.

Clients taking MAOIs must avoid high-tyraminefoods to prevent life-threatening hypertensive crisis. Foods and beverages to avoid include aged cheeses (eg, most cheeses except for cream and cottage cheese); protein-rich foods; and foods that have been processed (eg, hot dogs), pickled, fermented (eg, sauerkraut, pepperoni), or smoked (eg, smoked salmon). Most fruits and vegetables (eg, salad, broccoli) contain little to no tyramine

Question 19

tenecteplase

Answer 19

Thrombolytic agent

• are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
• They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
• contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage

Question 20

reteplase

Answer 20

Thrombolytic agent

• are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
• They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
• contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage

Question 21

amlodipine

Answer 21

(Norvasc) - Peripherally acting calcium channel blockers

• used to treat hypertension and do not worsen bronchoconstriction
• cause vasodilation, and clients may develop peripheral edema
• — This is an expected, frequent side effect and is not an allergic reaction.
• – Clients are advised to elevate the legs when lying down and to use stockings.

Question 22

felodipine

Answer 22

• Peripherally acting calcium channel blockers
• cause vasodilation, and clients may develop peripheral edema
• — This is an expected, frequent side effect and is not an allergic reaction.
• – Clients are advised to elevate the legs when lying down and to use stockings.

Question 23

diazepam

Answer 23

Benzodiazepine - commonly used antianxiety drugs.

• work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
• may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
• never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
• considered standard treatment to control agitation in the client in alcohol withdrawal
• IV diazepam used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic

Question 24

Vancomycin

Answer 24

(Vancocin) is a potent antibiotic used to treat gram-positive bacterial infections (eg, Staphylococcus aureus, Clostridium difficile).

• strong antibiotics that can cause nephrotoxicity and ototoxicity
• To lower the risk of dose-related nephrotoxicity, especially in clients with renal impairment and those who are >60 years of age, serum vancomycin trough levels should be monitored to assess for therapeutic range (10-20 mg/L).
• normal levels of creatinine (0.6-1.3 mg/dL) and BUN (6-20 mg/dL) are necessary in clients receiving vancomycin.

Question 25

omeprazole

Answer 25

proton pump inhibitor that suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach. In most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent stress ulcers from developing during surgery or a major illness. - Although evidence has shown that two-thirds of clients who receive PPIs do not need them, these medications are still widely prescribed in hospitalized clients. PPIs can be identified by their "-prazole" ending (eg, pantoprazole, lansoprazole, esomeprazole). - used for GERD, also used for ulcer tx, and prevention - PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. - PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. - can possibly cause C.diff - associated with increased risk of pneumonia, Clostridium difficile diarrhea, and calcium malabsorption (osteoporosis

Question 26

proton pump inhibitors =

Answer 26

prazoles - used for GERD - PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. - PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. - can possibly cause C.diff

Question 27

lansoprazole

Answer 27

proton pump inhibitor - used for GERD - PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. - PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. - can possibly cause C.diff

Question 28

pantoprazole

Answer 28

proton pump inhibitor - used for GERD, also used for ulcer tx and prevention - PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. - PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. - can possibly cause C.diff

Question 29

rebeprazole

Answer 29

proton pump inhibitor - used for GERD - PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. - PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. - can possibly cause C.diff

Question 30

Metronidazole

Answer 30

(Flagyl) first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile is the initial drug of choice for STIs. - Clients should avoid alcohol while taking metronidazole and for 24 hours after completion of the therapy due to a reaction that includes flushing, nausea/vomiting, and abdominal pain. - The medication can cause a metallic taste and turn the urine a deep red-brown color. - med of choice for c.diff - used for bacterial vaginosis, an overgrowth of vaginal bacterial flora

Question 31

phenytoin

Answer 31

- (Dilantin) is an anticonvulsant drug used to treat generalized tonic-clonic seizures. - The therapeutic serum phenytoin reference range is between 10-20 mcg/mL. - Good oral hygiene is necessary to avoid the potential complication of gingival hyperplasia - induce hepatic metabolism, which decreases the effectiveness of many other drugs, including oral contraceptives. - Use of alternative birth control methods is recommended - should not be stopped abruptly as this increases the risk of seizure - Early signs of toxicity include horizontal nystagmus and gait unsteadiness. These may be followed by slurred speech, lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are usually seen with intravenous phenytoin. - Steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity. Administration of phenytoin concurrent with certain drugs (eg, antacids, calcium) and/or enteral feedings can affect the absorption of phenytoin. - so stop tube feedings for 1-2 hrs before administering

Question 32

dicloxacillin

Answer 32

antistaphylococcal antibiotic

Question 33

cephalexin

Answer 33

antistaphylococcal antibiotic

Question 34

drugs used for v fib

Answer 34

epinephrine, vasopressin, amiodarone

Question 35

Epoetin

Answer 35

(Procrit) is a synthetic hormone that stimulates the production of erythropoietin and is used to treat anemia associated with chronic kidney disease. - stimulates the body to make additional red blood cells

Question 36

Sodium polystyrene sulfonate

Answer 36

(Kayexalate) is a sodium exchange resin administered to reduce elevated serum potassium levels in clients with chronic kidney disease and hyperkalemia. - works by exchanging sodium for potassium, and the excess potassium is excreted through the stool. In clients without normal bowel function (eg, post surgery, constipation, fecal impaction), there is a risk for intestinal necrosis. During sodium polystyrene sulfonate therapy, severe hypokalemia (palpitations, lethargy, cramping) can develop. Frequent monitoring of electrolyte status is required. Because potassium exchanges with sodium content of the resin, excess sodium absorption could put clients at risk of developing volume overload (water follows sodium). The client should be monitored for signs of fluid overload (eg, crackles, jugular venous distension, edema) and have daily weights and intake and output assessment.

Question 37

when discontinuing heparin and using warfarin

Answer 37

- Warfarin is started about 5 days before a continuous heparin infusion is discontinued. - An overlap of the parenteral and oral anticoagulant is required for about 5 days as this is the time it takes warfarin to reach therapeutic level. Warfarin begins to take effect in 48-72 hours and then takes several more days to achieve a maximum effect. Therefore, an overlap of a parenteral anticoagulant like heparin with warfarin is required. The typical overlap is 5 days or until the INR reaches the therapeutic level. The nurse will need to explain this overlap of the 2 medications to the client and the spouse.

Question 38

Carbidopa-levodopa

Answer 38

(Sinemet) - used for Parkinson's - Levodopa is converted to dopamine in the brain, but much of this drug is metabolized before reaching the brain. Carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect. This combination medication is particularly effective in treating bradykinesia (generalized slowing of movement). Tremor and rigidity may also improve to some extent. - once started should never be stopped suddenly as this can lead to akinetic crisis (complete loss of movement). However, prolonged use can also result in dyskinesias (spontaneous involuntary movements) and on/off periods when the medication will start or stop working unpredictably. - Orthostatic hypotension and neuropsychiatric disturbances (eg, confusion, hallucinations, delusions, agitation, psychosis) are serious and important adverse effects

Question 39

donepezil

Answer 39

(Aricept) - treatment of Alzheimer disease - used to improve cognition and memory used to prevent worsening of symptoms in Alzheimer dementia, and it does not decrease agitation. It is a preventive medication and so would be a lower priority.

Question 40

rivastigmine

Answer 40

- treatment of Alzheimer disease | - used to improve cognition and memory

Question 41

when on warfarin need to avoid

Answer 41

avoid aspirin, drugs containing aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and alcohol when taking warfarin due to an increased risk for bleeding - Clients should be taught to avoid trauma or injury to decrease the risk for bleeding. Preventive measures include gently brushing teeth with a soft-bristled toothbrush, avoiding use of alcohol-based mouthwash, avoiding contact sports or rollerblading, and using a straight razor. Flossing should also be avoided in general, but waxed dental floss may be used with care in some clients.

Question 42

Dicyclomine hydrochloride

Answer 42

(Bentyl) is an anticholinergic medication. - Anticholinergics are used to relax smooth muscle and dry secretions. - Anticholinergic side effects include pupillary dilation, dry mouth, urinary retention, and constipation. - Therefore, the classic contraindications are closed-angle glaucoma, bowel ileus, and urinary retention.

Question 43

carvedilol

Answer 43

(Coreg) beta blocker for treatment of chronic heart failure - block the negative effects of the sympathetic nervous system (increased heart rate) and reduce the cardiac workload. - However, they can worsen heart failure if used in the acute setting of this condition.

Question 44

beta blocker major side effects

Answer 44

bradycardia, bronchospasm, hypotension, depression, impotence

Question 45

captopril

Answer 45

angiotensin-converting enzyme inhibitor - can cause hyperkalemia - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP)

Question 46

angiotensin-converting enzyme inhibitor major side effects

Answer 46

dry cough, hypotension, reflex tachycardia, hyperkalemia, angioedema

Question 47

glipizide

Answer 47

sulfonylurea - The major adverse effects of sulfonylurea medications are hypoglycemia and weight gain. - Clients should be taught to use sunscreen and protective clothing as serious sunburns can occur. - Clients should avoid alcohol as it lowers blood glucose and can lead to severe hypoglycemia.

Question 48

sulfonylurea major side effects

Answer 48

hypoglycemia (diaphoresis, headache, hunger, tachycardia, confusion), a disulfiram-like reaction may occur if combined with alcohol

Question 49

thyroid replacement major side effects

Answer 49

symptoms of hyperthyroidism (diarrhea, weight loss, palpitations, tachycardia, sweating, heat intolerance)

Question 50

diphenhydramine =

Answer 50

(Benadryl) - antihistamine | - can prevent pruritus.

Question 51

Losartan is

Answer 51

an angiotensin II receptor blocker (ARB) prescribed to treat hypertension. - teratogenic, causing renal and cardiac defects or death of the fetus. there is a black box warnings that indicate contraindication in pregnancy. - can cause hyperkalemia so avoid with hyperkalemic pts - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP) - They are used in clients who cannot take ACE inhibitors (eg, lisinopril, ramipril)

Question 52

safe antihypertensives that are safe during pregnancy

Answer 52

labetalol, methyldopa

Question 53

labetalol

Answer 53

(Trandate), antihypertensive - used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg) - safe during pregnancy - can use for preeclampsia

Question 54

methyldopa

Answer 54

(Aldomet), antihypertensive - used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg) - safe during pregnancy - can use for preeclampsia

Question 55

clopidogrel

Answer 55

(plavix) - Antiplatelet agent prescribed to prevent thromboevimbolic events in clients with increased risk for stroke or myocardial infarction. - Laboratory values are monitored periodically as these drugs increase bleeding time (normal, 2-7 minutes [120-420 seconds]) and, rarely, may lower platelet count (normal, 150,000-400,000/mm3 ) - should be discontinued 5-7 days before surgery to decrease the risk for excessive bleeding. - prevent platelet aggregation and are given to clients to prevent stent re-occlusion. - They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage. - Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding.

Question 56

prednisone

Answer 56

corticosteroid - can increase glucose levels. Glucose levels should be monitored periodically for clients receiving this medication - when taken in combination with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, can increase the risk of gastrointestinal ulceration and bleeding. The client should report black, tarry stools (ie, melena) to the health care provider as they could indicate gastrointestinal bleeding - Clients taking corticosteroids should increase calcium and vitamin D intake to prevent bone loss, engage in physical activity to prevent weight gain, and watch for signs of infection as corticosteroids cause immunosuppression. Corticosteroids should not be stopped suddenly, especially in situations in which higher (stress)-dose steroids are required (eg, infection, trauma, surgery).

Question 57

Tiotropium

Answer 57

(Spiriva) - an inhaled anticholinergic drug that inhibits receptors in the smooth muscles of the airways. - It is prescribed daily for the long-term management of bronchospasm in clients with chronic obstructive pulmonary disease - is a long-acting, 24-hour, anticholinergic, inhaled medication used to control chronic obstructive pulmonary disease (COPD). It is administered most commonly using a capsule-inhaler system called the HandiHaler. The powdered medication dose is contained in a capsule. The client places the capsule in the inhaler device and pushes a button on the side of the device, which pokes a hole in the capsule. As the client inhales, the powder is dispersed through the hole. - Unlike most inhaled medications, tiotropium looks like an oral medication because it comes in a capsule. Therefore, it is important to teach the client proper administration prior to the first dose, emphasizing that the capsule should not be swallowed and that the button on the inhaler must be pushed to allow for medication dispersion. During future appointments, the nurse should assess/reassess the client's ability to use this medication correctly. - Clients should rinse the mouth after using tiotropium and inhaled steroids (eg, beclomethasone, budesonide, fluticasone) to remove any medication remaining in the mouth, which decreases the risk of developing thrush. - Tiotropium is a controller medication for COPD with a peak effect of approximately 1 week; therefore, it should not be used as a rescue medication. Instead, short-acting bronchodilators (eg, albuterol and/or ipratropium) should be used for symptom rescue. Clients must discontinue ipratropium before taking tiotropium as both are anticholinergic. - Anticholinergic inhaled medications (eg, ipratropium, tiotropium, umeclidinium) do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions. - a common side effect of tiotropium (Spiriva) and other anticholinergics (eg, ipratropium, benztropine) is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat

Question 58

permethrin

Answer 58

- used for scabies - applied to all body areas below the head. - important to inform the parents and child that itching will continue for several weeks after proper treatment is given

Question 59

gentamicin

Answer 59

aminoglycoside - strong antibiotic - can cause nephrotoxicity and ototoxicity. - should monitor the client's renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage. - Muscle cramping can occur occasionally with use of gentamicin but is not an indication to stop the infusion - Tinnitus (ringing in the ears) should be reported by a client taking these medications. The medication may need to be discontinued to prevent permanent hearing loss.

Question 60

amikacin

Answer 60

aminoglycoside - strong antibiotic - can cause nephrotoxicity and ototoxicity. - should monitor the client's renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage.

Question 61

tobramycin

Answer 61

aminoglycoside - strong antibiotic - can cause nephrotoxicity and ototoxicity. - should monitor the client's renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage. - Tinnitus (ringing in the ears) should be reported by a client taking these medications. The medication may need to be discontinued to prevent permanent hearing loss.

Question 62

methotrexate

Answer 62

- cancer drug - can cause decrease in the RBC count that may be evidence of bone marrow suppression (Rheumatrex) is classified as a folate antimetabolite, antineoplastic, immunosuppressant drug to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) to treat rheumatoid arthritis and psoriasis. Methotrexate is an immunosuppressant and can cause bone marrow suppression. Clients are at risk for infection. They should avoid crowded places and individuals with known infection and should receive appropriate killed (inactivated) vaccines (eg, influenza, pneumococcal). Live vaccines (eg, herpes zoster) are contraindicated. Adverse effects include hepatotoxicity, bone marrow suppression, infection risk, and fetal congenital abnormalities. Alcohol intake and live vaccines (eg, intranasal influenza vaccine) should be avoided. Killed/inactivated vaccines (eg, IM influenza injection) can be administered. Clients should not become pregnant while taking methotrexate or for at least 3 months after it is discontinued as the drug is teratogenic and can cause congenital abnormalities and fetal death. Clients taking methotrexate should avoid alcohol as the prescription drug is hepatotoxic and drinking alcohol increases the risk for hepatotoxicity.

Question 63

Valproate

Answer 63

(Depakote) - a medication used to control seizures - FDA pregnancy category D drug that can cause neural tube defects such as spina bifida

Question 64

A laboring client may experience lower back pain with contractions, or "back labor," when the fetus is

Answer 64

- in the right occiput posterior (ROP) position. - variation of vertex presentation causes the fetal occiput to exert added pressure on the woman's sacrum during contractions. - Positioning the woman on her hands and knees often helps decrease back pain and facilitates fetal rotation into an anterior position.

Question 65

Oxybutynin

Answer 65

(Ditropan) is an anticholinergic medication that is frequently used to treat overactive bladder. - also used for bladder spasms Common side effects include: - -New-onset constipation - -Dry mouth - -Flushing - -Heat intolerance - -Blurred vision - -Drowsiness - -Decreased sweat production may lead to hyperthermia. The nurse should instruct the client to be cautious in hot weather and during physical activity - -Sedation is a common side effect of anticholinergic drugs. Clients should be taught not to drive or operate heavy machinery until they know how the drug affects them.

Question 66

The therapeutic serum phenytoin reference range is between

Answer 66

10-20 mcg/mL.

Question 67

nitroprusside

Answer 67

(Nitropress, Nipride) is a vasodilator given via infusion and can be titrated to keep the BP within a desired parameter. - used IV in hypertensive crisis

Question 68

Nystatin

Answer 68

- used to treat oral candidiasis, or thrush, that can be caused by medications such as antibiotics, corticosteroids, or oral contraceptive pills. - available in the form of powders, suspensions, creams, ointments, and lozenges. - Oral suspensions are the more common form of nystatin used for oral candidiasis. The client should be directed to swish the solution within the mouth, making contact with all the mucous membranes, and then swallow the solution after several minutes. Swallowing would help to clear any unseen esophageal candidiasis.

Question 69

Codeine

Answer 69

- is an opioid drug prescribed as an analgesic to treat mild to moderate pain and as an antitussive to suppress the cough reflex. - Although the antitussive dose (10-20 mg orally every 4-6 hours) is lower than the analgesic dose, clients can still experience the common adverse effects (eg, constipation, nausea, vomiting, orthostatic hypotension, dizziness) associated with the drug. - decreases gastric motility, resulting in constipation. Increasing fluid intake and fiber in the diet and taking laxatives are effective measures to prevent constipation - Changing position slowly is effective in preventing the orthostatic hypotension associated with codeine, especially in the elderly - Taking the medication with food is effective in preventing the gastrointestinal irritation (eg, nausea, vomiting) associated with codeine - Depressing the cough reflex can cause an accumulation of secretions in the presence of chronic obstructive pulmonary disease (COPD), leading to respiratory difficulty. In general, sedatives (eg, narcotics, benzodiazepines) can also depress the respiratory center and effort; therefore, they should not be given to clients with respiratory diseases (eg, asthma, COPD).

Question 70

Spironolactone

Answer 70

- potassium-sparing diuretic and an aldosterone inhibitor - In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss. - can cause hyperkalemia so avoid with hyperkalemic pts - it is typically used in a client with liver failure, ascites, and edema to promote diuresis and to prevent fluid retention. If more diuresis is needed, then intravenous furosemide is used, often in combination with albumin infusion

Question 71

triamterene

Answer 71

- potassium-sparing diuretic. - In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss. - can cause hyperkalemia so avoid with hyperkalemic pts

Question 72

amiloride

Answer 72

- potassium-sparing diuretic. - In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss. - can cause hyperkalemia so avoid with hyperkalemic pts

Question 73

eplerenone

Answer 73

- potassium-sparing diuretic. - In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss. - can cause hyperkalemia so avoid with hyperkalemic pts

Question 74

metoprolol

Answer 74

beta blocker for heart failure - block the negative effects of the sympathetic nervous system (increased heart rate) and reduce the cardiac workload. - However, they can worsen heart failure if used in the acute setting of this condition. - can be used for heart rate control in tachyarrhythmias - can decrease HR Beta-adrenergic blockers are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperthyroidism in which excessive thyroid hormones are released into the circulation. Beta blockers block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism

Question 75

atenolol

Answer 75

beta blocker Beta-adrenergic blockers are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperthyroidism in which excessive thyroid hormones are released into the circulation. Beta blockers block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism can decrease HR

Question 76

Ipratropium

Answer 76

(Atrovent) is a short-acting inhaled anticholinergic often used in combination with a short-acting beta-agonist (eg, albuterol) to promote bronchodilation and reduce bronchospasm - used for symptom rescue - do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions. - a common side effect is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat

Question 77

Methylprednisolone

Answer 77

(Solu-Medrol) is a systemic glucocorticoid that improves respiratory symptoms and overall lung function in clients experiencing an exacerbation of COPD. - need to monitor blood glucose levels - can be used to decrease airway inflammation and swelling associated with the allergic reaction

Question 78

Nitroglycerin patches

Answer 78

- are transdermal patches used to prevent angina in clients with coronary artery disease. - They are usually applied once a day (not as needed) and worn for 12–14 hours and then removed. - Continuous use of patches without removal can result in tolerance. - No more than one patch at a time should be worn. The patch should be applied to the upper body or upper arms. - Clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused should be used. - A different location should be chosen each day to prevent skin irritation.

Question 79

tadalafil

Answer 79

- Phosphodiesterase inhibitors - used in erectile dysfunction - are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.

Question 80

sildenafil

Answer 80

Sildenafil - Phosphodiesterase inhibitors - used in erectile dysfunction - are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.

Question 81

vardenafil

Answer 81

- Phosphodiesterase inhibitors - used in erectile dysfunction - are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension.

Question 82

Tamoxifen

Answer 82

- has mixed agonist and antagonist activity on estrogen receptors in various tissues. - It is used for several years in estrogen-responsive breast cancer. - blocks estrogen so its helpful in inhibiting the growth of estrogen-receptive breast cancer cells - However, it is associated with increased risk of endometrial cancer and venous thromboembolism. - irregular or excessive menstrual bleeding in premenopausal women or any bleeding in postmenopausal women can be a sign of endometrial cancer - due to its estrogen- agonist actions, also poses a risk for thromboembilc events (stroke, pulmonary embolism, and DVT) - Menopausal symptoms (eg, vaginal dryness, hot flashes, sexual dysfunction) are the most common side effect.

Question 83

IV gamma globulin

Answer 83

- given for Kawasaki disease - IVIG creates high plasma oncotic pressure, and signs of fluid overload and pulmonary edema develop if it is given in large quantities. Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing).

Question 84

Allopurinol

Answer 84

- prescribed to prevent gout attacks (pain and inflammation in joints caused by uric acid deposits). - inhibits uric acid production and improves solubility. - should be taken with a full glass of water, and it is very important for the nurse to educate the client about fluid intake with this medication. - The client should also increase daily fluid intake as this will help prevent the formation of renal stones and promote diuresis (increase drug and uric acid excretion) - also used is to decrease hyperuricemia caused by Tumor Lysis Syndrome. - -Laboratory values of significance in TLS include rising blood uric acid, potassium, and phosphate levels, with decreasing calcium levels.

Question 85

lispro

Answer 85

- (Humalog) - rapid-acting insulin used as a bolus insulin for meals. - "see food" insulin and should not be administered until the food is in sight. - A sliding insulin (correction) scale is used to prescribe rapid-acting

Question 86

Magnesium sulfate

Answer 86

- central nervous system depressant used to prevent/control seizure activity in preeclampsia/eclampsia clients. - During administration, the nurse should assess vital signs, intake and output, and monitor for signs of magnesium toxicity (eg, decreased deep-tendon reflexes, respiratory depression, decreased urine output). A therapeutic magnesium level of 4-7 mEq/L is necessary to prevent seizures in a preeclamptic client. - also used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.

Question 87

Hydralazine

Answer 87

(Apresoline) - antihypertensive | - used to lower blood pressure (BP) if needed (usually considered when BP is >160/110 mm Hg)

Question 88

terbutaline

Answer 88

Tocolytic drug - used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.

Question 89

indomethacin

Answer 89

Tocolytic drug - used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity. Nonsteroidal anti-inflammatory drug (NSAID) - inhibit prostaglandin synthesis and can be taken to decrease pain and inflammation or to reduce fever. NSAIDs are pregnancy category C in the first and second trimesters and pregnancy category D in the third trimester. NSAIDs must be avoided during the third trimester due to the risk of causing premature closure of the ductus arteriosus in the fetus. During the first and second trimesters, NSAIDs should be taken only if benefits outweigh risks and under the supervision of a health care provider (HCP). All NSAIDs are associated with the following: - Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food. - Kidney injury - long-term use is associated with kidney injury - Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension - Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding.

Question 90

Desmopressin acetate (DDAVP)

Answer 90

is a synthetic form of Antidiuretic hormone, which can be administered intravenously, orally, or via nasal spray. - Effectiveness of therapy with desmopressin would be manifested by decreased urinary output and increased urine specific gravity as the urine becomes less dilute - used to treat nocturnal enuresis so it reduces urine production during sleep.

Question 91

imipramine

Answer 91

- Tricyclic antidepressant - improve functional bladder capacity so used to treat nocturnal enuresis - The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision

Question 92

amitriptyline

Answer 92

(Elavil)- Tricyclic antidepressant - used to treat depression and neuropathic pain - improve functional bladder capacity so used to treat nocturnal enuresis - The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision - can also be used for for diabetic neuropathy are usually given on a fixed, timed schedule - used to treat pain in Fibromyalgia

Question 93

desipramine

Answer 93

- Tricyclic antidepressant - improve functional bladder capacity so used to treat nocturnal enuresis - The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision

Question 94

Sodium bicarbonate

Answer 94

is an electrolyte replenisher and is administered intravenously to correct moderate to severe metabolic acidosis (pH <7.2).

Question 95

Enoxaparin

Answer 95

- low-molecular-weight heparin used in the prevention and treatment of DVT. - It is administered as a deep subcutaneous injection and is usually given in the abdomen. - The injection should be made on the right or left side of the abdomen, at least 2 in from the umbilicus. An inch of skin should be pinched up and the injection made into the fold of skin with the needle inserted at a 90-degree angle. - The complete blood count (CBC) should be assessed periodically with the administration of enoxaparin, an anticoagulant. The nurse would want to assess the hemoglobin, hematocrit, and platelet count levels. If these levels are low, the client will be at risk for increased bleeding

Question 96

levonorgestrel

Answer 96

[Plan B] | - should be taken within 5 days of intercourse; however, efficacy is reduced after 3 days (72 hours).

Question 97

copper intrauterine device (IUD)

Answer 97

may be inserted for up to 5 days after intercourse as another form of emergency contraception.

Question 98

etanercept

Answer 98

(Enbrel) Tumor Necrosis Factor Inhibitor - block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. - reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. - The medication causes immunosuppression and increased susceptibility for infection and malignancies - Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. - S/E: severe infections and bone marrow suppression

Question 99

infliximab

Answer 99

(Remicade) Tumor Necrosis Factor Inhibitor - block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. - reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. - The medication causes immunosuppression and increased susceptibility for infection and malignancies - Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. - S/E: severe infections and bone marrow suppression

Question 100

adalimumab

Answer 100

(Humira) Tumor Necrosis Factor Inhibitor - block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. - reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. - The medication causes immunosuppression and increased susceptibility for infection and malignancies - Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. - S/E: immunosuppression with severe infections and bone marrow suppression

Question 101

bismuth subsalicylate

Answer 101

the nurse should tell the parent to discontinue the use of bismuth subsalicylate (Pepto-Bismol) as it contains a salicylate (same class as aspirin) and could possibly cause Reye syndrome. Reye syndrome can develop in children with a recent viral illness such as varicella or influenza. It can cause acute encephalopathy and hepatic dysfunction. Children with viral infections should not be given aspirin or products containing salicylates.

Question 102

simvastatin

Answer 102

- statin - avoid grapefruit juice!! - may result in myopathy - prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. - Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day.

Question 103

Nicardipine

Answer 103

(Cardene) - calcium channel blocking vasodilator. - takes effect within 1 minute of IV administration. - essential to monitor that the blood pressure is not being lowered too quickly or too slowly as this would extend the stroke. - Hypotension can occur with or without reflex tachycardia. The drug must be discontinued if hypotension or reflex tachycardia occurs.

Question 104

Widening of the QT interval can increase the risk of life-threatening torsades de pointes. It is most commonly seen with

Answer 104

haloperidol (Haldol), methadone, ziprasidone (Geodon), and erythromycin

Question 105

Cholestyramine

Answer 105

(Questran) may be prescribed to increase the excretion of bile salts in the feces, thereby decreasing pruritus. - It is packaged in a powdered form, must be mixed with food (applesauce) or juice (apple juice), and should be given one hour after all other medications are administered.

Question 106

Ethambutol

Answer 106

(Myambutol) is used in combination with other antitubercular drugs (eg, isoniazid, rifampin, pyrazinamide) to treat active tuberculosis. - can cause ocular toxicity - The client must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect. - The client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination.

Question 107

rifampin

Answer 107

(Rifadin) - antitubercular also causes hepatotoxicity. Therefore, baseline liver function tests should be obtained. Clients should be advised to watch for signs and symptoms of hepatotoxicity (eg, jaundice, anorexia). Ethambutol causes ocular toxicity, and clients will need frequent eye examinations. A teaching plan for a client prescribed rifampin includes these additional instructions: - -Rifampin changes the color of body fluids (eg, urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored. Client should wear eyeglasses instead of soft contact lenses while taking this medication. - changes to red/orange color - -Women should use nonhormonal birth control methods while taking this drug as it can decrease the effectiveness of oral contraceptives. - - Clients should be advised to not consume alcohol and drugs that can increase the risk for hepatotoxicity (eg, acetaminophen) during long-term use of this drug.

Question 108

pyrazinamide

Answer 108

- antitubercular - Dark-colored urine and yellow skin can indicate the presence of hepatotoxicity, which is associated with many drugs used to treat tuberculosis

Question 109

Streptomycin

Answer 109

- aminoglycoside antibiotic, is a second-line drug sometimes used to treat multi-drug-resistant tuberculosis, with ototoxic and nephrotoxic adverse effects. - Difficulty hearing (tinnitus, subjective hearing loss) is an adverse reaction to streptomycin

Question 110

prasugrel

Answer 110

(Effient) antiplatelet - prevent platelet aggregation and are given to clients to prevent stent re-occlusion. - They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage. - Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding.

Question 111

ticagrelor

Answer 111

[Brilinta] antiplatelet - prevent platelet aggregation and are given to clients to prevent stent re-occlusion. - They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage. - Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding.

Question 112

furosemide

Answer 112

- loop diuretic

Question 113

torsemide

Answer 113

- loop diuretic

Question 114

bumetanide

Answer 114

- loop diuretic - used to treat edema associated with heart failure and liver and renal disease. The diuretic inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water and potassium. - The nurse should question the bumetanide prescription as the client with heart failure has hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]) and is already at increased risk for life-threatening cardiac dysrhythmias associated with this electrolyte imbalance

Question 115

rosuvastatin

Answer 115

(Crestor) is a strong statin drug that can cut LDL drastically and reduce total cholesterol and triglycerides. It also increases HDL - Baseline liver enzymes are obtained - prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. - Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day. - A serious complication associated with statin medication is rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances can be harmful to the kidney and often cause kidney damage. The client should immediately report any signs of muscle aches or weakness to the HCP. These could be early signs of rhabdomyolysis, which can be fatal. - A serious adverse effect of statins, is myopathy with ongoing generalized muscle aches and weakness. - -A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued.

Question 116

atorvastatin

Answer 116

(Lipitor) is a statin drug, or HMG-CoA reductase inhibitor, prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease - Baseline liver enzymes are obtained - prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. - Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day. - Muscle cramps and liver injury, are the major adverse effects of statin medications - A serious adverse effect of statins, is myopathy with ongoing generalized muscle aches and weakness. - -A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued.

Question 117

methylphenidate

Answer 117

(Ritalin) - is a central nervous system stimulant used to treat ADHD and narcolepsy. It affects neurotransmitters (dopamine and norepinephrine) in the brain that contribute to hyperactivity and lack of impulse control. - administered in divided doses 2 or 3 times daily, usually 30-45 minutes before meals. - As a stimulant, methylphenidate may interfere with sleep and should be given no later than around 6:00 PM. - The sustained-release preparation should be given in the morning. - The dosage in children is usually started low and titrated to the desired response. - Children should be monitored closely during initial treatment for development of tics and continuously for adherence and response to therapy A common side effect of methylphenidate is loss of appetite with resulting weight loss. Parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development. It is very important to compare weight/height measures from one well-child checkup to the next. If weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferable. Another side effect of methylphenidate is increased blood pressure and tachycardia. These should be monitored before and after starting treatment with stimulants. The major problems with stimulant medications include: - Decreased appetite and weight loss – can lead to growth delays - Cardiovascular effects – hypertension and tachycardia (particularly in adults) - Appearance of new or exacerbation of vocal/motor tics - Excess brain stimulation – restlessness, insomnia - Abuse potential – misuse, diversion, addiction

Question 118

lisdexamfetamine

Answer 118

Stimulant - used in the treatment of ADHD The major problems with stimulant medications include: - Decreased appetite and weight loss – can lead to growth delays - Cardiovascular effects – hypertension and tachycardia (particularly in adults) - Appearance of new or exacerbation of vocal/motor tics - Excess brain stimulation – restlessness, insomnia - Abuse potential – misuse, diversion, addiction

Question 119

dextroamphetamine

Answer 119

Stimulant - used in the treatment of ADHD The major problems with stimulant medications include: - Decreased appetite and weight loss – can lead to growth delays - Cardiovascular effects – hypertension and tachycardia (particularly in adults) - Appearance of new or exacerbation of vocal/motor tics - Excess brain stimulation – restlessness, insomnia - Abuse potential – misuse, diversion, addiction

Question 120

Lithium

Answer 120

- mood stablizer used in the treatment of bipolar disorder. - It has expected, mild side effects as well as potentially serious ones related to drug toxicity. Drowsiness, weight gain, dry mouth, and gastrointestinal upset are expected, mild side effects. - Lithium toxicity occurs with dehydration, hyponatremia, decreased renal function, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs, thiazide diuretics). Lithium and sodium are closely related in the body. Acute viral gastroenteritis (stomach flu) presents with abrupt onset of diarrhea, nausea, vomiting, and abdominal pain. Clients with vomiting and diarrhea are at risk of developing dehydration and/or low serum sodium, increasing the risk for lithium toxicity - Drowsiness is an expected side effect. The nurse should advise the client to avoid hazardous activities and driving until the effects of lithium are known or this side effect subsides. - Weight gain is an expected side effect. The nurse should provide client education about healthy food choices and proper exercise and/or provide for a dietary consult. - Dry mouth is an expected side effect. The nurse should provide client teaching about measures to counteract this side effect (eg, ice chips, sugarless gum or candy, drinking plenty of water). However, excessive urination and polydipsia indicate nephrogenic diabetes insipidus from lithium toxicity. It has a very narrow therapeutic serum range of 0.6-1.2 mEq/L (0.6-1.2 mmol/L). Levels >1.5 mEq/L (1.5 mmol/L) are considered toxic. Lithium toxicity usually occurs with the following: - Dehydration - Decreased renal function (eg, elderly clients) - Diet low in sodium - Drug-drug interactions (nonsteroidal anti-inflammatory drugs [NSAIDs] and thiazide diuretics) Lithium is cleared renally. Even a mild change in kidney function (as seen in elderly clients) can cause serious lithium toxicity. Therefore, drugs that decrease renal blood flow (eg, NSAIDs) should be avoided. Acetaminophen would be a better choice for pain relief Several medications can cause increased lithium levels, including thiazide diuretics (eg, hydrochlorothiazide), nonsteroidal anti-inflammatory drugs, and antidepressants. Thiazide diuretics have demonstrated the greatest potential to increase lithium concentrations, with a possible 25%-40% increase in concentrations Lithium is excreted through the kidneys. To prevent toxicity the nurse should hold doses and clarify prescriptions for clients who have: - Conditions/illnesses in which the kidneys try to conserve sodium (eg, hyponatremia, dehydration) as sodium and lithium are absorbed in proximal tubules simultaneously - Decreased glomerular filtration rate (eg, severe renal dysfunction) as less of the drug is filtered into the urine Consistent amounts of fluid (2-3 L/day) and sodium prevent fluctuations in serum lithium. Clients should report signs (eg, weight changes, dizziness) and precipitating factors (eg, vomiting, diarrhea, increased sweating) of fluid and electrolyte imbalance.

Question 121

Flumazenil

Answer 121

is the appropriate antidote for a benzodiazepine overdose.

Question 122

calcium gluconate

Answer 122

antidote for magnesium toxicity - recommended only in the event of cardiorespiratory compromise. - Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence. Once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis)

Question 123

Amoxicillin/clavulanate

Answer 123

belongs to aminopenicillin group and is often used to treat respiratory infections. Instructions for parents about amoxicillin include: - The medication may be taken with or without food as food does not affect absorption - The most common side effects of this medication are nausea, vomiting, and diarrhea. If nausea or diarrhea develops, the medicine may be administered with food to decrease the gastrointestinal side effects - Shake the liquid well prior to administration. Administer at evenly spaced intervals throughout the day to maintain therapeutic blood levels - Ensure that the child receives the full course of therapy; do not discontinue the medication if the child is feeling better or symptoms have resolved

Question 124

Lactulose

Answer 124

- is the most common treatment for hepatic encephalopathy. - syruplike liquid that decreases intestinal ammonia absorption in pts with liver disease and hepatic encephalopathy - not digested or absorbed until it reaches the large intestines where it is metabolized, producing an acidic environment and a hyperosmotic effect (laxative). In this acidic environment, ammonia (NH3) is converted to ammonium (NH4+) and excreted rapidly. - Lactulose can be given orally with water, juice, or milk (to improve flavor) or it can be administered via enema - For faster results, it can be administered on an empty stomach - The desired therapeutic effect of lactulose is the production of 2-3 soft bowel movements each day; therefore, the dose is titrated until the therapeutic effect is achieved. - This therapeutic dose should not be held but instead should be maintained until the desired outcomes are reached (improved mental status, decreased ammonia levels) - The client's electrolyte levels should be closely monitored during therapy as lactulose is a laxative that can cause dehydration, hypernatremia, and hypokalemia.

Question 125

transdermal fentanyl patch

Answer 125

- prescribed for clients suffering from moderate to severe chronic pain. - The patch provides continuous analgesia for up to 72 hours. However, the drug is absorbed slowly through the skin into the systemic circulation and can take up to 17 hours to reach its full analgesic effect. - Therefore, it is not recommended for treating acute postoperative, temporary, or intermittent pain as it does not provide immediate analgesia when applied.

Question 126

lidocaine 5% transdermal patch

Answer 126

- provides a localized, topical anesthetic to intact skin. - commonly prescribed for clients with chronic postherpetic neuralgia, a painful, debilitating condition that can develop following a herpes zoster (shingles) infection.

Question 127

IV infusion of potassium chloride (KCL).

Answer 127

- The infusion rate should not exceed 10 mEq/hr (10 mmol/hr). - Therefore, IVPB KCL must be given via an infusion pump so the rate can be regulated. - IV KCL should be diluted and never given in a concentrated amount. Furthermore, too rapid infusion can cause cardiac arrest.

Question 128

Pyridostigmine

Answer 128

(Mestinon) is a first-line drug that inhibits acetylcholine breakdown and is prescribed to temporarily increase muscle strength in clients with Myasthenia gravis.

Question 129

Acetylsalicylic acid

Answer 129

(Aspirin) is prescribed daily to prevent ischemic attacks and myocardial infarction in clients with coronary artery disease and ischemic stroke

Question 130

Metformin

Answer 130

(Glucophage) is an anti-hyperglycemic drug that can cause lactic acidosis in clients with kidney disease - Major side effects of metformin are lactic acidosis and gastrointestinal disturbances (metallic taste in the mouth, nausea, and diarrhea). Iodinated contrast used for CT scan or cardiac catheterization can cause kidney injury. Metformin (Glucophage) can worsen lactic acidosis in the presence of kidney injury. Metformin should be withheld prior to the contrast exposure and can be resumed when kidney function is within normal limits.

Question 131

IV furosemide may cause

Answer 131

ototoxicity, particularly when high doses are administered in clients with compromised renal function. - The rate of administration should not exceed 4 mg/min in doses >120 mg. To determine the correct rate of administration for the dose above, use the following formula: (Dose = mg) / (4 mg/min) = ___ min

Question 132

Topical capsaicin cream

Answer 132

(Zostrix) is an over-the-counter analgesic that effectively relieves minor pain (eg, osteoarthritis, neuralgia). - The nurse should instruct the client to wait at least 30 minutes after massaging the cream into the hands before washing to ensure adequate absorption - The client should avoid contact with mucous membranes (eg, nose, mouth, eyes) or skin that is not intact, as capsaicin is a component of hot peppers and can cause burning. - When applying cream to other areas of the body (eg, knee), the client should wear gloves or wash hands immediately after application. - The application of heat with capsaicin is contraindicated as heat causes vasodilation, which increases medication absorption and can possibly lead to a chemical burn. - Capsaicin should be used regularly (3-4 times daily) for long periods (eg, weeks to months) to achieve the desired effect.

Question 133

naproxen

Answer 133

nonsteroidal anti-inflammatory drugs - to effectively treat osteoarthritis pain. - when taken in combination with Glucocorticoids (eg, prednisone), can increase the risk of gastrointestinal ulceration and bleeding. The client should report black, tarry stools (ie, melena) to the health care provider as they could indicate gastrointestinal bleeding NSAIDs are pregnancy category C in the first and second trimesters and pregnancy category D in the third trimester. NSAIDs must be avoided during the third trimester due to the risk of causing premature closure of the ductus arteriosus in the fetus. During the first and second trimesters, NSAIDs should be taken only if benefits outweigh risks and under the supervision of a health care provider (HCP). All NSAIDs are associated with the following: - Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food. - Kidney injury - long-term use is associated with kidney injury - Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension - Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding.

Question 134

celecoxib

Answer 134

(Celebrex), a COX-2 inhibitor, nonsteroidal anti-inflammatory drugs - to effectively treat osteoarthritis pain. has a black box warning for increased risk of cardiovascular complications. Myocardial infarction symptoms, which can be vague in female clients, include nausea and upper back and shoulder pain. These symptoms would be the priority to assess first, and immediate testing (ie, ECG, cardiac enzymes) would be warranted

Question 135

penicillin allergy and cephalosporin antibiotics.

Answer 135

A client with a penicillin allergy may be allergic to cephalosporin antibiotics. Cephalosporins may be safely administered to clients with a history of mild allergic reaction, such as rash, but they are contraindicated in clients with a history of penicillin anaphylaxis.

Question 136

cefazolin

Answer 136

(Ancef) Cephalosporin antibiotic - a bone-penetrating cephalosporin antibiotic that is active against skin flora (Staphylococcus aureus) - it is given prophylactically before and after surgery to prevent infection

Question 137

D5W

Answer 137

hypotonic fluid - decreases the circulatory volume. - may be more appropriate for a client with hypoglycemia

Question 138

normal saline

Answer 138

isotonic solution | - will increase circulatory volume

Question 139

lactated Ringer

Answer 139

isotonic solutions | - will increase circulatory volume

Question 140

Norepinephrine

Answer 140

(Levophed) - causes vasoconstriction and improved heart contractibility/output. - When the medication is stopped suddenly, its effects end quickly. It should be tapered slowly to avoid the progression or relapse of shock.

Question 141

dopamine

Answer 141

(Intropin) vasoactive medication - is a sympathomimetic inotropic medication often used to treat hypotension not caused by hypovolemia. - It enhances cardiac output by increasing myocardial contractility, increasing heart rate and elevating blood pressure through vasoconstriction. - Renal perfusion is also improved, resulting in increased urine output. - The lowest effective dose of dopamine should be used as dopamine administration leads to an increased cardiac workload. - Significant adverse effects include tachycardia, dysrhythmias, myocardial ischemia, nausea, and vomiting

Question 142

Signs and symptoms of digoxin toxicity include

Answer 142

1. Gastrointestinal symptoms (eg, anorexia, nausea, vomiting, abdominal pain) are frequently the earliest symptoms 2. Neurologic manifestations (eg, lethargy, fatigue, weakness, confusion) 3. Visual symptoms are characteristic and include alterations in color vision, scotomas, or blindness 4. Cardiac arrhythmias – most dangerous - Digoxin is a cardiac glycoside administered to clients with heart failure to improve cardiac output and efficiency by increasing cardiac contractility and decreasing heart rate. Early signs of toxicity include gastrointestinal disturbances (eg, nausea, vomiting, diarrhea, anorexia). Bradycardia (<60/min in adults) and visual disturbances (seeing yellow-green halos around lights) are later signs of digoxin toxicity - Drug levels are frequently monitored until a steady state is achieved and when changes are expected, such as in clients with chronic kidney disease and electrolyte disturbances (eg, hypokalemia, hypomagnesemia). - Digoxin toxicity can result in bradycardia and heart block. Clients are instructed to check their pulse and report to the HCP if it is low or has skipped beats. - Digoxin toxicity can be seen with levels >2 ng/mL. Potassium levels should also be monitored in the client receiving digoxin. Hypokalemia can potentiate digoxin toxicity

Question 143

senna

Answer 143

stimulant for bm

Question 144

docusate

Answer 144

stool softener

Question 145

ondansetron

Answer 145

Antiemetic (Zofran)

Question 146

Rifapentine

Answer 146

(Priftin), a derivative of rifampin - antitubercular agent used with other drugs (eg, isoniazid) as a combination therapy in active and latent tuberculosis infections. - Both rifampin and rifapentine reduce the efficacy of oral contraceptives by increasing their metabolism; therefore, use an alternate birth control plan (non-hormonal) to prevent pregnancy during treatment - should be taken with meals for best absorption and to prevent stomach upset. - Hepatotoxicity may occur -- liver function tests are required at least every month. Signs and symptoms of hepatitis include jaundice of the eyes and skin, fatigue, weakness, nausea, and anorexia. - may cause red-orange-colored body secretions, which is an expected finding. Dentures and contact lenses may be permanently stained.

Question 147

Isoniazid

Answer 147

- (INH) is a first-line antitubercular drug prescribed as monotherapy to treat latent tuberculosis infection. Combined with other drugs, INH is also used for active tuberculosis treatment. - Two serious adverse effects of INH use are hepatotoxicity and peripheral neuropathy. - Dark-colored urine and yellow skin can indicate the presence of hepatotoxicity, which is associated with many drugs used to treat tuberculosis - Baseline liver enzymes are obtained - question giving med if elevated liver enzymes (alanine aminotransferase, aspartate aminotransferase) - elevation can indicate development of drug induced hepatitis

Question 148

A teaching plan for a client prescribed Isoniazid (INH) includes the following:

Answer 148

- Avoid intake of alcohol and limit use of other hepatotoxic agents (eg, acetaminophen) to reduce risk of hepatotoxicity - Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy - Avoid aluminum-containing antacids (eg, aluminum hydroxide (Maalox)) within 1 hour of taking INH - use of antacids containing aluminum decreases INH absorption. The medication may be taken with food if gastric irritation is a concern. - Report changes in vision (eg, blurred vision, vision loss) - Report signs/symptoms of severe adverse effects such as: - --Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue) - --Peripheral neuropathy (eg, numbness, tingling of extremities)

Question 149

pyridoxine

Answer 149

vitamin B6

Question 150

aluminum hydroxide

Answer 150

Maalox - aluminum-containing antacid

Question 151

Nortriptyline

Answer 151

- Tricyclic antidepressant - The most common side effects: dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision

Question 152

insulin used for potassium problems

Answer 152

- Intravenous regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells. - Dextrose is administered concurrently to prevent hypoglycemia. - Although intravenous regular insulin will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias.

Question 153

Glargine

Answer 153

(Lantus) is a basal insulin with no peak, - also known as a "background insulin." - should not be mixed with any other insulin - give in its own syringe

Question 154

Tissue plasminogen activator

Answer 154

(tPA) dissolves clots and restores perfusion in clients with ischemic stroke. - It must be administered within a 3- to 4½-hour window from onset of symptoms for full effectiveness. - The nurse assesses for contraindications to tPA due to the risk of hemorrhage.

Question 155

Bupropion hydrochloride

Answer 155

(Wellbutrin) is an atypical antidepressant used to treat depressive disorders, including major depressive disorder, seasonal affective disorder, and persistent depressive disorder (dysthymia). Preparations of bupropion hydrochloride include immediate-release, sustained release (SR), and extended-release (XL) tablets. - Any medication marked SR or XL should not be chewed, cut, or crushed due to the risk of adverse effects from too rapid absorption of the drug. No form of bupropion hydrochloride should be altered; tablets should be swallowed whole, with or without food. Seizures are of particular concern if a client takes a high or toxic dose of bupropion hydrochloride. - Clients on any kind of antidepressant need to be monitored closely for worsening depression, sudden or unusual behavior or mood changes, and the emergence of suicidal thoughts and behaviors. Clients with a diagnosis of depression and/or their family members need education and information on the increased risk of suicide - can be used for smoking cessation Additional instructions to a client about the use of bupropion hydrochloride include the following: - Limit alcohol; inform the health care provider if you are used to consuming large amounts of alcohol - Do not double up on the medication if a scheduled dose is missed - Take the medication at the same time each day - It may take several weeks to feel the effects of bupropion hydrochloride - Weight loss may occur when taking this medication

Question 156

Selective serotonin reuptake inhibitors (SSRIs)

Answer 156

- commonly used to treat major depression and anxiety disorders. - (eg, fluoxetine, paroxetine, citalopram, escitalopram, sertraline) - generally well tolerated except for sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). The major side effects of SSRIs include increased suicide risk (at the beginning of therapy), sexual dysfunction, weight gain, and serotonin syndrome (excess doses). It may take several weeks for the therapeutic effects of SSRIs to begin; they should never be discontinued abruptly.

Question 157

fluoxetine

Answer 157

(Prozac) Selective serotonin reuptake inhibitor - commonly used to treat major depression and anxiety disorders. - generally well tolerated except for sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). Common, expected side effects of SSRIs include: - Loss of appetite; weight loss or weight gain - Gastrointestinal disturbances (nausea, vomiting, diarrhea) - Headaches, dizziness, drowsiness, insomnia - Sexual dysfunction Side effects should gradually diminish over 3 months, although some may persist. If symptoms are intolerable or a particular SSRI is ineffective, the client may be switched to a different antidepressant. - Clients usually see therapeutic effects in 1-4 weeks. SSRIs may increase the risk of suicide, especially in young adults (age 18-24) during initial therapy or after a dosage increase. A client who reports increased energy without a change in depressive feelings needs to be assessed and monitored for suicidal ideation or actions as the client may now have the energy to execute the suicide plan - don't take with st johns wort

Question 158

paroxetine

Answer 158

Selective serotonin reuptake inhibitor - commonly used to treat major depression and anxiety disorders. - generally well tolerated except for sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). Common, expected side effects of SSRIs include: - Loss of appetite; weight loss or weight gain - Gastrointestinal disturbances (nausea, vomiting, diarrhea) - Headaches, dizziness, drowsiness, insomnia - Sexual dysfunction Side effects should gradually diminish over 3 months, although some may persist. If symptoms are intolerable or a particular SSRI is ineffective, the client may be switched to a different antidepressant. - Clients usually see therapeutic effects in 1-4 weeks. SSRIs may increase the risk of suicide, especially in young adults (age 18-24) during initial therapy or after a dosage increase. A client who reports increased energy without a change in depressive feelings needs to be assessed and monitored for suicidal ideation or actions as the client may now have the energy to execute the suicide plan - don't take with st johns wort

Question 159

citalopram

Answer 159

(Celexa) Selective serotonin reuptake inhibitor - commonly used to treat major depression and anxiety disorders. - generally well tolerated except for sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). Common, expected side effects of SSRIs include: - Loss of appetite; weight loss or weight gain - Gastrointestinal disturbances (nausea, vomiting, diarrhea) - Headaches, dizziness, drowsiness, insomnia - Sexual dysfunction Side effects should gradually diminish over 3 months, although some may persist. If symptoms are intolerable or a particular SSRI is ineffective, the client may be switched to a different antidepressant. - Clients usually see therapeutic effects in 1-4 weeks. SSRIs may increase the risk of suicide, especially in young adults (age 18-24) during initial therapy or after a dosage increase. A client who reports increased energy without a change in depressive feelings needs to be assessed and monitored for suicidal ideation or actions as the client may now have the energy to execute the suicide plan - don't take with st johns wort

Question 160

escitalopram

Answer 160

(Lexapro) Selective serotonin reuptake inhibitor - commonly used to treat major depression and anxiety disorders. - generally well tolerated except for sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). - usually take 1-4 weeks from the first dose to improve depression symptoms. If a client experiences no improvement after 2 months, re-evaluation is necessary

Question 161

sertraline

Answer 161

(Zoloft) Selective serotonin reuptake inhibitor - commonly used to treat major depression and anxiety disorders. - generally well tolerated except for sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). Common, expected side effects of SSRIs include: - Loss of appetite; weight loss or weight gain - Gastrointestinal disturbances (nausea, vomiting, diarrhea) - Headaches, dizziness, drowsiness, insomnia - Sexual dysfunction Side effects should gradually diminish over 3 months, although some may persist. If symptoms are intolerable or a particular SSRI is ineffective, the client may be switched to a different antidepressant. - Clients usually see therapeutic effects in 1-4 weeks. SSRIs may increase the risk of suicide, especially in young adults (age 18-24) during initial therapy or after a dosage increase. A client who reports increased energy without a change in depressive feelings needs to be assessed and monitored for suicidal ideation or actions as the client may now have the energy to execute the suicide plan - don't take with st johns wort

Question 162

chlordiazepoxide

Answer 162

benzodiazepine | - considered standard treatment to control agitation in the client in alcohol withdrawal

Question 163

Meperidine

Answer 163

(Demerol) - contraindicated for a sickle cell crisis as large frequent doses can result in normeperidine (toxic metabolite) accumulation. Symptoms start with tremors and can result in a seizure

Question 164

Midazolam

Answer 164

(Versed) is a benzodiazepine commonly used to induce conscious sedation in clients undergoing endoscopic procedures. - The initial dose is 1 mg and is titrated up slowly (eg, 2 minutes before each 1-mg increment) until speech becomes slurred. Usually no more than 3.5 mg is necessary to induce conscious sedation. It is commonly administered with an opioid analgesic (eg, morphine, Fentanyl) because of their synergistic effects. - Side effects can include airway occlusion, apnea, hypotension (especially in the presence of an opioid), and oxygen desaturation with resultant respiratory arrest. - Flumazenil (Romazicon) is the antidote drug used to reverse the sedative effects of benzodiazepines.

Question 165

Flumazenil

Answer 165

(Romazicon) is the antidote drug used to reverse the sedative effects of benzodiazepines.

Question 166

Naloxone

Answer 166

(Narcan) is the antidote drug to reverse the effects of opioids. The half-life of naloxone (Narcan) is shorter than most narcotics. When naloxone is used to reverse the effects of narcotics, the nurse must monitor the client to ensure that the client does not fall again into excessive sedation and/or respiratory depression. WEARS OFF - 1-2 hours

Question 167

Phentolamine

Answer 167

(Regitine) is the antidote drug used to treat a norepinephrine (Levophed) extravasation.

Question 168

Cyclobenzaprine

Answer 168

(Flexeril), a central and peripheral muscle relaxant given to treat pain associated with muscle spasm

Question 169

carisoprodol

Answer 169

(Soma) - muscle relaxer

Question 170

methocarbamol

Answer 170

(Robaxin) - muscle relaxer

Question 171

Tetanus and diphtheria toxoid

Answer 171

an immunization given prophylactically to prevent infection (Clostridium tetani) if immunizations are not up to date (>10 years), unavailable, or unknown

Question 172

Ketorolac

Answer 172

(Toradol), a nonsteroidal anti-inflammatory drug given to decrease inflammation and pain

Question 173

Clonidine patch

Answer 173

is a potent antihypertensive agent and is available as a transdermal patch. The patches should be replaced every 7 days and can be left in place during bathing. Instructions for using the clonidine (transdermal) patch: - Apply the patch to a dry hairless area on the upper outer arm or chest once every 7 days - Do not shave the area before applying the patch. The skin should be free from cuts, scrapes, calluses, or scars - Wash hands with soap and water before and after applying the patch as some medication may remain on the hands after application. - Wash the area with soap and water, then rinse and wipe with a clean, dry tissue. - Remove the patch from the package. Do not touch the sticky side. - Rotate sites of patch application with each new patch. Remove the old patch only when applying a new one. Do not wear more than 1 patch at a time unless directed by your health care provider (HCP). - When removing the patch, fold it in half with the sticky sides together. Discard the patch out of the reach of children and pets. Even after it has been used, the patch contains active medicine that may be harmful if accidentally applied or ingested - Notify the HCP if you are experiencing side effects such as dizziness or slow pulse rate. Do not remove the patch without discussing this with the HCP as rebound hypertension can occur

Question 174

Miconazole

Answer 174

(Monistat), an antifungal cream commonly prescribed to treat vaginal candidiasis, is inserted high into the vagina using an applicator. - It is best applied at bedtime so that it will remain in the vagina for an extended period - can also be used for ringworm

Question 175

Beclomethasone

Answer 175

(Beconase) is an inhaled corticosteroid (ICS) normally used as a long-term, first-line drug to control chronic airway inflammation. - Clients should rinse the mouth after using inhaled steroids

Question 176

brachytherapy

Answer 176

- Internal radiation involves direct application of a radioactive implant to the cancerous site or tumor for a short time, usually 24–72 hours. - This technique is used to treat cervical and endometrial cancer and delivers a high dose of radiation to the cancerous tissues with a limited dose to adjacent normal tissues. Implementation of the following nursing measures is vital as the client receiving brachytherapy emits radiation. Following the principles of time, distance, and shielding provides staff and visitors protection from exposure to radiation. - Time spent near the radiation source is restricted. The guideline is to limit staff time spent in the room to 30 minutes per shift. - Cluster nursing care to minimize exposure to the radiation source - Rotate daily staff responsibilities to limit time spent in the client room - All staff must wear a dosimeter film badge when assigned to care for a client receiving internal radiation - No individuals who are pregnant or under age 18 may be in the room - All staff and visitors must keep the maximum distance possible from the radiation source. Maintaining a distance of at least 6 feet is an established standard. - Assign the client to a private room with a private bath - Keep the door to the room closed - Ensure that a sign stating, "Caution, Radioactive Material" is affixed to the door - Instruct the client to remain on bedrest to prevent dislodgement of the implant - Shielding with lead diminishes exposure to radiation. All staff providing nursing care that requires physical contact must wear a lead apron.

Question 177

budesonide

Answer 177

- inhaled corticosteroid (ICS) | - Clients should rinse the mouth after using inhaled steroids

Question 178

fluticasone

Answer 178

- inhaled corticosteroid (ICS) | - Clients should rinse the mouth after using inhaled steroids

Question 179

umeclidinium

Answer 179

Anticholinergic inhaled medications - do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions.

Question 180

conivaptan

Answer 180

Vasopressin receptor antagonists | - tx of SIADH

Question 181

abciximab

Answer 181

Glycoprotein (GP) IIb/IIIa receptor inhibitor - used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications. - can cause serious bleeding. The nurse should closely monitor the client for any bleeding at the groin puncture site after the percutaneous coronary intervention - The nurse should check the client's baseline complete blood count (eg, hemoglobin, platelet count). Some clients may develop serious thrombocytopenia within a few hours, further increasing the bleeding risk. Hypotension, tachycardia, changes in heart rhythm, blood in the urine, abdominal/back pain, mental status changes, and black tarry stools may also indicate internal bleeding and should be monitored carefully when GP IIb/IIIa receptor inhibitors are administered - During and after the infusion of GP IIb/IIIa receptor inhibitors, no traumatic procedures (initiation of IV sites, intramuscular injections) should be performed unless absolutely necessary due to the risk of bleeding

Question 182

eptifibatide

Answer 182

Glycoprotein (GP) IIb/IIIa receptor inhibitor - used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications. - can cause serious bleeding. The nurse should closely monitor the client for any bleeding at the groin puncture site after the percutaneous coronary intervention - The nurse should check the client's baseline complete blood count (eg, hemoglobin, platelet count). Some clients may develop serious thrombocytopenia within a few hours, further increasing the bleeding risk. Hypotension, tachycardia, changes in heart rhythm, blood in the urine, abdominal/back pain, mental status changes, and black tarry stools may also indicate internal bleeding and should be monitored carefully when GP IIb/IIIa receptor inhibitors are administered - During and after the infusion of GP IIb/IIIa receptor inhibitors, no traumatic procedures (initiation of IV sites, intramuscular injections) should be performed unless absolutely necessary due to the risk of bleeding

Question 183

tirofiban

Answer 183

Glycoprotein (GP) IIb/IIIa receptor inhibitor - used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications. - can cause serious bleeding. The nurse should closely monitor the client for any bleeding at the groin puncture site after the percutaneous coronary intervention - The nurse should check the client's baseline complete blood count (eg, hemoglobin, platelet count). Some clients may develop serious thrombocytopenia within a few hours, further increasing the bleeding risk. Hypotension, tachycardia, changes in heart rhythm, blood in the urine, abdominal/back pain, mental status changes, and black tarry stools may also indicate internal bleeding and should be monitored carefully when GP IIb/IIIa receptor inhibitors are administered - During and after the infusion of GP IIb/IIIa receptor inhibitors, no traumatic procedures (initiation of IV sites, intramuscular injections) should be performed unless absolutely necessary due to the risk of bleeding

Question 184

clonidine

Answer 184

Central-acting alpha2 agonists - decrease the sympathetic response from the brainstem to the peripheral vessels, resulting in decreased peripheral vascular resistance and vasodilation. - Clonidine is a highly potent antihypertensive. Abrupt discontinuation (including the patch) can result in serious rebound hypertension due to the rapid surge of catecholamine secretion that was suppressed during therapy. Clonidine should be tapered over 2-4 days. Abrupt withdrawal of beta blockers can also result in rebound hypertension and in precipitation of angina, myocardial infarction, or sudden death. - Avoiding high-sodium foods is important for blood pressure control but is not the most important advice for this client as consumption of these is not immediately life-threatening. - Dizziness is a side effect of clonidine. The nurse should teach the client to change positions slowly and sit for a few minutes before rising to prevent falls. Drowsiness is also quite common with clonidine. Clients should not use it with alcohol or central nervous system depressants. However, dizziness and drowsiness should diminish with continued use of the medication. - Dry mouth is a side effect of clonidine. Use of over-the-counter mouth moisturizers, chewing gum, or hard candy may be helpful for clients with dry mouth.

Question 185

duloxetine

Answer 185

(Cymbalta) is a serotonin-norepinephrine reuptake inhibitor that has both antidepressant and pain-relieving effects. It is used to relieve chronic pain that interferes with normal sleep patterns in clients with Fibromyalgia. With the restoration of normal sleep patterns, fatigue often improves as well - Medication for diabetic neuropathy - usually given on a fixed, timed schedule

Question 186

pregabalin

Answer 186

Medication for diabetic neuropathy - usually given on a fixed, timed schedule has both antidepressant and pain-relieving effects. It is used to relieve chronic pain that interferes with normal sleep patterns in clients with Fibromyalgia. With the restoration of normal sleep patterns, fatigue often improves as well

Question 187

gabapentin

Answer 187

(Neurontin) Medication for diabetic neuropathy | - usually given on a fixed, timed schedule

Question 188

Ziprasidone hydrochloride

Answer 188

(Geodon) is an atypical antipsychotic drug that is used for acute bipolar mania, acute psychosis, and agitation. - considered standard treatment to control violent behavior in the client with schizophrenia - It carries a risk for QT prolongation leading to torsade de pointes. A baseline electrocardiogram and potassium are usually checked. At a minimum, the client should be placed on a cardiac monitor. - The client should also be monitored for hypotension and seizures, especially if the previous medical history is not known or obtainable. - The risk for adverse effects is increased with the interaction of alcohol.

Question 189

Valsartan

Answer 189

Angiotension II receptor blocker - can cause hyperkalemia so avoid with hyperkalemic pts - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP) - They are used in clients who cannot take ACE inhibitors (eg, lisinopril, ramipril)

Question 190

Candesartan

Answer 190

Angiotension II receptor blocker - can cause hyperkalemia so avoid with hyperkalemic pts - They are used in clients who cannot take ACE inhibitors (eg, lisinopril, ramipril)

Question 191

Lisinopril

Answer 191

(Prinivil) angiotensin-converting enzyme inhibitor prescribed to treat hypertension and slow the progression of heart failure - can cause hyperkalemia so avoid with hyperkalemic pts - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP) - should not be used in pregnancy as they can affect kidney development in the fetus. - Lisinopril has a low incidence of serious adverse effects except angioedema (rapid swelling of lips, tongue, throat, face, and larynx). Angioedema can lead to airway obstruction and possible death. ACE inhibitors are the most frequent medications causing drug-induced angioedema. The risk is 5 times greater for African Americans than for Caucasians. If clients experience symptoms of angioedema, they are instructed to discontinue the drug and notify the HCP immediately.

Question 192

Ramipril

Answer 192

angiotensin-converting enzyme inhibitor - can cause hyperkalemia so avoid with hyperkalemic pts - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP)

Question 193

Filgrastin

Answer 193

(Neupogen) is used to increase the neutrophil count in clients with certain malignancies and in those undergoing chemotherapy. Neutropenia is expected in this client

Question 194

drugs dangerous to elderly

Answer 194

The Beers criteria provide a list that classifies potentially harmful drugs to avoid or administer with caution in the elderly due to the high incidence of drug-induced toxicity, cognitive dysfunction, and falls. Some commonly used medications in this list include antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales.

Question 195

Enalapril

Answer 195

angiotensin-converting enzyme inhibitor - is used to treat high blood pressure and heart failure - can cause hyperkalemia so avoid with hyperkalemic pts - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP)

Question 196

Telmisartan

Answer 196

an angiotensin receptor blocker - can cause hyperkalemia so avoid with hyperkalemic pts - Salt substitutes contain high potassium and must not be consumed unless approved by the health care provider (HCP)

Question 197

Levofloxacin

Answer 197

a fluoroquinolone antibiotic prescribed to treat urinary tract infections, has no known cross-sensitivity to penicillin. However, cross-sensitivity with other fluoroquinolones can occur For this class of antibiotics, 2 hours should pass between drug ingestion and consumption of aluminum/magnesium antacids, iron supplements, multivitamins with zinc, or sucralfate. These substances can bind up to 98% of the drug and make it ineffective

Question 198

Sucralfate

Answer 198

(Carafate, Sulcrate), is an oral medication that forms a protective layer in the gastrointestinal mucosa, which provides a physical barrier against stomach acids and enzymes. It doesn't neutralize or reduce acid production. It is prescribed to treat and prevent both stomach and duodenal ulcers. - prescribed to treat gastric ulcers This medication is generally prescribed 1 hour BEFORE meals and at bedtime and, for effective results, is administered on an empty stomach with a glass of water. should be administered before meals to coat the mucosa and prevent irritation of the ulcer during meals. It should also be given at least 2 hours before or after other medications to prevent interactions that reduce drug efficacy. Sucralfate also binds with many other medications (eg, digoxin, warfarin, phenytoin) and reduces their bioavailability. Therefore, all other medications are generally administered at least 1-2 hours before or after sucralfate administration. Constipation is a common side effect of this medication

Question 199

Loperamide

Answer 199

(Imodium) is a synthetic opioid used as an antidiarrheal. It slows peristalsis and subsequently increases fluid absorption. It should not be used more than 2 days or if fever is present as retention of bacteria or toxins inside the colon can make the process worse and cause toxic megacolon

Question 200

Epinephrine

Answer 200

administered for cardiac arrest, anaphylactic reactions, or severe asthma attacks Epinephrine counteracts the effect of the histamines released, dilating bronchial smooth muscles and providing vasoconstriction. Most deaths from anaphylaxis are due to delaying epinephrine

Question 201

atropine

Answer 201

an anticholinergic agent, is used to treat bradycardia Clients with symptomatic bradycardia should be treated with atropine. If atropine is ineffective, transcutaneous pacing or an infusion of dopamine or epinephrine should be considered

Question 202

Glucagon

Answer 202

Naturally produced by the pancreas, glucagon is given intramuscularly, subcutaneously, or intravenously for severe hypoglycemia. IV glucose is preferred due to its immediate effect; however, if it is unavailable, glucagon can be given to stimulate glycogenolysis in the liver, thereby raising blood glucose

Question 203

dantrolene

Answer 203

required IV for the emergent treatment of Malignant hyperthermia to reverse the process by slowing metabolism

Question 204

what meds should be held before dialysis

Answer 204

Medication administration may require modification on days that clients are scheduled to receive dialysis. The nurse should consider whether the medication will be dialyzed out of the client's system or may create adverse effects during dialysis. Fluid is removed during dialysis, which may cause hypotension. Typically, antihypertensives are held before dialysis to prevent hypotension. In addition, some medications are dialyzed out of the client's system and should therefore be held until after dialysis. Commonly held medications are water-soluble vitamins (eg, vitamins B and C), antibiotics, and digoxin

Question 205

nitroglycerin

Answer 205

vasodilator used to treat stable angina. It is a sublingual tablet or spray that is placed under the client's tongue. It usually relieves pain in about 3 minutes and lasts 30-40 minutes. The recommended dose is 1 tablet or 1 spray taken sublingually for angina every 5 minutes for a maximum of 3 doses. If symptoms are unchanged or worse 5 minutes after the first dose, emergency medical services (EMS) should be contacted. Previously, clients were taught to call EMS after the third dose was taken, but newer studies suggest that this leads to a significant delay in treatment. The NTG should be easily accessible at all times. Tablets are packaged in a light-resistant bottle with a metal cap. They should be stored away from light and heat sources, including body heat, to protect from degradation. Clients should be instructed to keep the tablets in the original container. Once opened, the tablets lose potency and should be replaced every 6 months. The car is not a good place to store NTG due to heat Current evidence indicates that up to 50% of clients lack knowledge about administration procedures, storage, and side effects of NTG. Proper teaching can prevent many hospital visits for chest pain from stable angina. The client should be instructed to take 1 pill (or 1 spray) every 5 minutes for up to 3 doses, but emergency medical services (EMS) should be called if pain is unimproved or worsening 5 minutes after the first tablet. Previously, clients were taught to call EMS after the third dose, but newer studies suggest that this causes a significant delay in treatment NTG should cause a slight tingling sensation under the tongue if it is potent; otherwise, the medication is likely outdated. The oral mucosa needs to be moist for adequate absorption of NTG, and clients should be instructed to take a drink of water before administration if needed for dry mouth. Sublingual tablets should never be swallowed. If using a spray, the client should not inhale it but direct it onto/under the tongue instead. Intravenous nitroglycerin (glyceryl trinitrate) is used to increase cardiac blood flow and provide pain relief for clients with ACS until a definitive treatment plan (eg, percutaneous coronary intervention, thrombolytic therapy, bypass surgery) is determined. Because nitroglycerin is a vasodilator, continuous hemodynamic monitoring is required to prevent severe hypotension. The infusion rate is titrated by the nurse based on pain level and blood pressure (BP), usually every 3-5 minutes until pain is relieved and BP is stable. If systolic BP drops to <90 mm Hg or falls >30 mm Hg below client baseline, the infusion rate should be decreased or stopped.

Question 206

oxytocin

Answer 206

(a uterine stimulant) is used to induce labor. Contractions can become too strong after oxytocin is used and lead to reduced placental blood flow. Reduced placental blood flow can result in non-reassuring fetal heart rate (FHR) patterns such as late decelerations, fetal bradycardia, tachycardia, or minimal variability. These non-reassuring FHR patterns may necessitate emergency cesarean birth, which would not have been required if the labor had not been induced.

Question 207

alendronate

Answer 207

(Fosamx) biophosphonate given for osteoporosis - decrease bone resorption so that loss of bone density is minimized - must be consumed in the morning, on an empty stomach, with at least 30 minutes before other drugs - take with a full glass of water and the client must remain upright for at least 30 minutes to aid absorption and prevent esophageal irritation

Question 208

risedronate

Answer 208

(Actonel) biophosphonate given for osteoporosis - decrease bone resorption so that loss of bone density is minimized - must be consumed in the morning, on an empty stomach, with at least 30 minutes before other drugs - take with a full glass of water and the client must remain upright for at least 30 minutes to aid absorption and prevent esophageal irritation

Question 209

zoledronic

Answer 209

(Reclast) biophosphonate | given for osteoporosis

Question 210

belladonna-opium suppository

Answer 210

used for bladder spasms

Question 211

potassium chloride

Answer 211

commonly prescribed to correct or prevent hypokalemia. The normal range for serum potassium is 3.5-5.0 mEq/L. Potassium is commonly lost through diarrhea, vomiting, and diuretic use. Oral KCl is available in extended-release tablets, capsules, dissolvable packets, and effervescent tablets, and as an oral liquid. If a client has difficulty swallowing large pills, the nurse should consult the pharmacist to see if other forms of KCl are currently available and to determine if the medication is safe to crush. If a more appropriate form (eg, liquid) is available, the nurse would then discuss that change in route with the health care provider and obtain an updated prescription. Clients receiving KCl IV should have periodic cardiac monitoring during therapy, as changes in potassium levels can cause cardiac rhythm disturbances and rapid infusion can cause cardiac arrest. Potassium is a vesicant; therefore, the IV insertion site should be monitored frequently for extravasation to prevent tissue necrosis The maximum infusion rate of KCl through a peripheral line is 10 mEq/hr and the maximum concentration is 40 mEq/L. Higher rates and concentrations require a central venous catheter Renal function should be assessed as clients with impaired renal function are unable to excrete potassium and other electrolytes effectively, potentially leading to toxicity. To assess renal function, the nurse should monitor renal function laboratory results (eg, blood urea nitrogen, creatinine) and urine output

Question 212

levetracetamin

Answer 212

(keppra) is an anticonvulsant prescribed for seizure disorders. As with other antiseizure medications, levetiracetam has a depressing effect on the central nervous system (CNS), which may cause drowsiness, somnolence, and fatigue as clients adjust to the medication. Clients should be assured that this is common and typically improves within 4-6 weeks. However, the CNS-depressing effects of levetiracetam may be enhanced if taken with other CNS-depressing substances (eg, alcohol) or medications. New or increased agitation, anxiety, and/or depression or mood changes should be reported immediately as levetiracetam is associated with suicidal ideation Like other anticonvulsants, levetiracetam can trigger Stevens-Johnson syndrome, a rare but life-threatening blistering reaction of the skin. Rash, blistering, muscle/joint pain, or conjunctivitis should be reported and assessed immediately

Question 213

butorphanol tartrate

Answer 213

(Stadol) Opioid agonist-antagonist medication commonly used in labor IV push is the preferred route and is given over the peak of 2 contractions to decrease the bolus of medication to the fetus. During contractions, the uterine muscle is very tense and blood flow to the fetus is slowed. Therefore, medication reaches the fetus at a slower rate. This class of medications has a ceiling effect—after a certain dosage, subsequent or higher doses will not be effective or produce pain relief. Therefore, usually no more than 3 doses will be prescribed. The medications can precipitate withdrawal in opioid-dependent clients and should not be used

Question 214

nalbuphine hydrochloride

Answer 214

(Nubain) Opioid agonist-antagonist medication commonly used in labor IV push is the preferred route and is given over the peak of 2 contractions to decrease the bolus of medication to the fetus. During contractions, the uterine muscle is very tense and blood flow to the fetus is slowed. Therefore, medication reaches the fetus at a slower rate. This class of medications has a ceiling effect—after a certain dosage, subsequent or higher doses will not be effective or produce pain relief. Therefore, usually no more than 3 doses will be prescribed. The medications can precipitate withdrawal in opioid-dependent clients and should not be used

Question 215

calcium acetate

Answer 215

(PhosLo) phosphate binder used to treat hyperphsphatemia (normal phosphorous 2.3-4.4 mg/dL) in pts with kidney disease - lowers the serum phosphorous levels by binding to dietary phosphate and excreting it in feces

Question 216

metoclopramide

Answer 216

(Reglan) is prescribed for the treatment of delayed gastric emptying, gastroesophageal reflux (GERD), and as an antiemetic. - It is commonly used to treat nausea/vomiting and gastroparesis Similar to antipsychotic drugs, metoclopramide use is associated with extrapyramidal adverse effects, including tardive dyskinesia (TD). This is especially common in older adults with long-term use. The client should call the health care provider immediately if TD symptoms develop, including uncontrollable movements such as: - Protruding and twisting of the tongue - Lip smacking - Puffing of cheeks - Chewing movements - Frowning or blinking of eyes - Twisting fingers - Twisted or rotated neck (torticollis)

Question 217

Albuterol

Answer 217

(Proventil) is a short-acting inhaled beta-2 agonist used to control airway obstruction caused by chronic obstructive pulmonary disease, asthma, or bronchitis. It also is used to prevent exercise-induced asthma. The therapeutic effect is relaxation of the smooth muscles of the airways, which results in immediate bronchodilation. Bronchodilation decreases airway resistance, facilitates mucus drainage (expectorates mucus plugs), decreases the work of breathing, and increases oxygenation. As a result of these actions, the respiratory rate will decrease and peak flow will be increased (if tested). However, short-acting beta-2 agonists are associated with the following side effects (not therapeutic effects): tremor (most frequent), tachycardia and palpitations, restlessness, and hypokalemia. these side effects are due to the oral deposition of medication (subsequent systemic absorption) and can be reduced with the use of a spacer or chamber device Dosing in an acute asthma exacerbation should not exceed 2-4 puffs every 20 minutes x 3. If albuterol is not effective, an inhaled corticosteroid is indicated to treat the inflammatory component of the disease. Albuterol is a sympathomimetic drug. Expected side effects mimic manifestations related to stimulation of the sympathetic nervous system, and commonly include insomnia, nausea and vomiting, palpitations (from tachycardia), and mild tremor - The albuterol canister should be shaken prior to inhalation to ensure appropriate medication delivery

Question 218

doxycycline

Answer 218

(Doryx) should not be used during pregnancy as it can impair bone mineralization in the fetus

Question 219

isotretintoin

Answer 219

oral acne medication derived from vitamin A - used only to treat severe and/or cystic acne not responding to other treatments due to side effects (stevens-johnson syndrome, suicide risk) - category X drug during pregnancy - exposure to any amount of med during pregnancy can cause birth defects - pts have to pledge to use 2 forms of birth control - teach pts to avoid vitamin A - vitamin A toxicity would cause increased intracranial pressure, gastrointestinal upset, liver damage, and changes in skin and nails - blood donation is prohibited while on this medication

Question 220

thyroxine

Answer 220

(Synthroid) in pregnancy should be monitored carefully to provide an appropriate dose for the physiological changes of maternity, but it is not teratogenic

Question 221

heparin

Answer 221

With a heparin drip infusion, the goal is to reach the therapeutic range of the drug's effect and not the "normal" or "control value." Once the therapeutic effect range has been reached (usually 1.5-2.0 times the control value), it usually remains within this range without titrating the heparin infusion rate. Heparin has a short duration (approximately 2-6 hours IV). Therefore, if it is not being infused, the aPTT level will go back to the control value (aPTT level without administration of anticoagulants). In addition, the volume of heparin being infused is small (because the standard concentration is 100 units/mL) so it is possible to miss an infiltration.

Question 222

memantine

Answer 222

is used to ease the symptoms of moderate to severe Alzheimer disease (AD), thereby improving the quality of life for clients and caregivers. Memantine is an N-methyl-D-aspartate (NMDA) antagonist that works by binding to NMDA receptors, blocking the brain's NMDA glutamate pathways, and protecting brain cells from overexposure to glutamate (excess levels of glutamate contribute to brain cell death). improvement may be seen in the client's behavior, cognitive functioning, and ability to perform activities of daily living

Question 223

aspart

Answer 223

(NovoLOG) is a rapid-acting insulin with an onset of 10-15 minutes. Onset is the time it takes for the insulin to enter the circulation and begin to lower blood glucose. The peak effect takes 30 minutes-3 hours and the duration of action is 3-5 hours. It is important for the nurse to ensure that the client eats within 15 minutes of administration of aspart/lispro/glulisine to prevent an insulin-related hypoglycemic reaction

Question 224

loratadine

Answer 224

(Claritin) H1 receptor antagonist - decrease the inflammatory response by blocking histamine receptors. Histamine is released from mast cells during a type I (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic conjunctivitis, and hives)

Question 225

venlafaxine

Answer 225

?

Question 226

hydroxychloroquine

Answer 226

However, frequent eye examinations are required for clients prescribed the nonbiologic antimalarial DMARD hydroxychloroquine (Plaquenil) as it can cause retinal damage.

Question 227

thiamine

Answer 227

Clients with chronic alcohol abuse suffer from poor nutrition related to improper diet and altered nutrient absorption. Poor thiamine intake and/or absorption can lead to Wernicke encephalopathy, a serious complication that manifests as altered mental status, oculomotor dysfunction, and ataxia. Clients are prescribed thiamine to prevent this condition Clients with alcoholism can have hypoglycemia. They can also have thiamine (vitamin B1) deficiency related to poor nutrient intake (a healthy diet contains enough thiamine) and alcohol-induced suppression of thiamine absorption. Thiamine deficiency can result in Wernicke encephalopathy (WE). Untreated WE can lead to death or neurologic morbidity (Korsakoff psychosis). In the setting of alcoholism, administered glucose is oxidized by using all the existing thiamine in the body; this can worsen thiamine deficiency, which in turn can precipitate the development of WE in a previously unaffected individual. Because the signs of alcohol intoxication and WE are similar, all intoxicated clients should be given IV thiamine before or with IV glucose

Question 228

what lab to monitor when on warfarin

Answer 228

INR

Question 229

chemical restraints

Answer 229

are medications (eg, benzodiazepines, psychotropics) used to restrict freedom of movement or to control socially disruptive behavior in clients who have no medical indications for them

Question 230

5% albumin

Answer 230

Colloid solution - infused into the intravascular space, it mobilizes fluid from the extravascular tissues into the extracellular vascular space. - it is expensive - can be used in clients with low intravascular protein (albumin) content and hypotension but increased fluid in extravascular tissues (eg, cirrhosis with ascites).

Question 231

dextrose 5% and lactated Ringer's

Answer 231

a hypertonic solution - infused into the intravascular space, it mobilizes fluid from the extravascular tissue into the extracellular vascular space.

Question 232

dextrose 5% and water

Answer 232

a hypotonic solution - In large volumes, it can cause shift of the fluid into the extravascular compartment, which may cause further hypotension in clients with low blood pressure. - typically used to treat hypernatremia

Question 233

0.45% saline

Answer 233

Hypotonic solution - In large volumes, it can cause shift of the fluid into the extravascular compartment, which may cause further hypotension in clients with low blood pressure. - typically used to treat hypernatremia

Question 234

Baclofen

Answer 234

Skeletal muscle relaxant - used in cerebral palsy to control spasticity and seizures. - Cerebral palsy is characterized by abnormal muscle tone and lack of coordination with spasticity

Question 235

Bisoprolol

Answer 235

beta blockers for treatment of chronic heart failure. - block the negative effects of the sympathetic nervous system (increased heart rate) and reduce the cardiac workload. - However, they can worsen heart failure if used in the acute setting of this condition.

Question 236

Isosorbide

Answer 236

(nitrate) used with hydralazine for African American clients with heart failure; - this combination decreases cardiac workload by reducing preload and afterload

Question 237

varenicline

Answer 237

can be used for smoking cessation

Question 238

Riluzole

Answer 238

(Rilutek) is the only medication approved for ALS treatment. - a glutamate antagonist, is thought to slow neuron degeneration by decreasing the production and activity of the neurotransmitter glutamate in the brain and spinal cord. - In some clients, riluzole may slow disease progression and prolong survival by 3-6 months. - The nurse should provide teaching about the purpose of the medication so that the client can make an informed decision about taking it

Question 239

Immunoglobulin

Answer 239

used to prevent coronary aneurysms and subsequent occlusion.

Question 240

erythropoietin

Answer 240

(eg, epoetin alfa) | - stimulate the bone marrow to produce more red blood cells, resulting in increased hematocrit and hemoglobin levels

Question 241

azithromycin

Answer 241

macrolide antibiotic - can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes. Therefore, an electrocardiogram (ECG) should be monitored. Concurrent use of macrolide antibiotics with other drugs that prolong QT interval (eg, amiodarone, sotalol, haloperidol, ziprasidone, azole antifungals) will further increase this risk. - Macrolides can also cause hepatotoxicity when taken in high doses or in combination with other hepatotoxic medications such as acetaminophen, phenothiazines, and sulfonamides. Elevation of aspartate transaminase and alanine transaminase levels (liver enzymes) may indicate that hepatotoxicity is occurring, and the nurse should report these results to the HCP.

Question 242

erythromycin

Answer 242

macrolide antibiotic - can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes. Therefore, an electrocardiogram (ECG) should be monitored. Concurrent use of macrolide antibiotics with other drugs that prolong QT interval (eg, amiodarone, sotalol, haloperidol, ziprasidone, azole antifungals) will further increase this risk. - Macrolides can also cause hepatotoxicity when taken in high doses or in combination with other hepatotoxic medications such as acetaminophen, phenothiazines, and sulfonamides. Elevation of aspartate transaminase and alanine transaminase levels (liver enzymes) may indicate that hepatotoxicity is occurring, and the nurse should report these results to the HCP.

Question 243

clarithromycin

Answer 243

macrolide antibiotic - can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes. Therefore, an electrocardiogram (ECG) should be monitored. Concurrent use of macrolide antibiotics with other drugs that prolong QT interval (eg, amiodarone, sotalol, haloperidol, ziprasidone, azole antifungals) will further increase this risk. - Macrolides can also cause hepatotoxicity when taken in high doses or in combination with other hepatotoxic medications such as acetaminophen, phenothiazines, and sulfonamides. Elevation of aspartate transaminase and alanine transaminase levels (liver enzymes) may indicate that hepatotoxicity is occurring, and the nurse should report these results to the HCP.

Question 244

dipyridamole

Answer 244

antiplatelet

Question 245

Filgrastim

Answer 245

(Neupogen) stimulate neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it - commonly used when pts taking chemo to increase neutrophils

Question 246

pegfilgrastim

Answer 246

(Neulasta) stimulate neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it - commonly used when pts taking chemo to increase neutrophils

Question 247

rasburicase

Answer 247

Cancer chemotherapy causes cell lysis, which results in tumor lysis syndrome due to massive release of nucleic acid and its metabolic product, uric acid. Uric acid deposition leads to acute kidney injury. Medications such rasburicase and aggressive IV hydration are used to prevent this complication.

Question 248

glimepiride

Answer 248

sulfonylurea - The major adverse effects of sulfonylurea medications are hypoglycemia and weight gain. - Clients should be taught to use sunscreen and protective clothing as serious sunburns can occur. - Clients should avoid alcohol as it lowers blood glucose and can lead to severe hypoglycemia.

Question 249

neomycin

Answer 249

aminoglycoside - Tinnitus (ringing in the ears) should be reported by a client taking these medications. The medication may need to be discontinued to prevent permanent hearing loss.

Question 250

fluconazole

Answer 250

(Diflucan) a broad-spectrum antifungal agent | - used to treat oral candidiasis

Question 251

Hydrochlorothiazide

Answer 251

thiazide diuretic for treating hypertension. The major side effects of thiazide diuretics include: - Hypokalemia (manifests as muscle cramps) - Hyponatremia (manifests as altered mental status and seizures) - Hyperuricemia (may worsen gout attacks) - Hyperglycemia (requires adjustment of diabetic medications) Of the above side effects, hypokalemia is the most serious as it can lead to life-threatening cardiac arrhythmias. - so ask pts if they have muscle cramps

Question 252

chlorthalidone

Answer 252

thiazide diuretic for treating hypertension. The major side effects of thiazide diuretics include: - Hypokalemia (manifests as muscle cramps) - Hyponatremia (manifests as altered mental status and seizures) - Hyperuricemia (may worsen gout attacks) - Hyperglycemia (requires adjustment of diabetic medications) Of the above side effects, hypokalemia is the most serious as it can lead to life-threatening cardiac arrhythmias. - so ask pts if they have muscle cramps

Question 253

med for severe C difficile infection

Answer 253

oral vancomycin may be used; intravenous vancomycin is ineffective.

Question 254

Ceftriaxone

Answer 254

(Rocephin) is a cephalosporin antibiotic

Question 255

what should be assessed prior to starting therapy with statin medications (eg, rosuvastatin, simvastatin, pravastatin, atorvastatin)

Answer 255

the client's liver function tests should be assessed. - The drug is metabolized by the hepatic enzyme system and could cause drug-induced hepatitis and increased liver enzymes. - Liver function tests should be assessed prior to the start of therapy.

Question 256

ibandronate

Answer 256

(Boniva) Bisphosphonate given for osteoporosis - decrease bone resorption so that loss of bone density is minimized - must be consumed in the morning, on an empty stomach, with at least 30 minutes before other drugs - take with a full glass of water and the client must remain upright for at least 30 minutes to aid absorption and prevent esophageal irritation

Question 257

acetylcysteine

Answer 257

(Mucomyst) mucolytic

Question 258

Levetiracetam

Answer 258

(Keppra) is a medication often used to treat seizures in various settings. It has minimal drug-drug interactions compared to phenytoin and is often the preferred antiepileptic medication.

Question 259

Dexamethasone

Answer 259

a corticosteroid, is used to treat cerebral edema associated with a brain injury/tumor by decreasing inflammation. - need to monitor blood glucose

Question 260

rivaroxaban

Answer 260

anticoagulant - reduce risk of blood clot

Question 261

apixaban

Answer 261

anticoagulant- reduce risk of blood clot

Question 262

isotonic fluids

Answer 262

Isotonic IV fluids expand only the extracellular fluid and are used as fluid replacement for fluid volume deficit. Common examples are normal saline and lactated Ringer's

Question 263

The use of hormonal contraception (ie, estrogen with or without progestin)

Answer 263

places women at a 2- to 4-fold increased risk for developing blood clots due to resulting hypercoagulability. Hormone levels vary among contraceptives, and higher levels of hormone content correlate to an increased risk of adverse thrombotic events (eg, stroke, myocardial infarction). Clients who are prescribed oral contraceptive pills (OCPs) containing estrogen should be educated on potential warning signs (eg, chest pain, vision loss, severe leg pain) (Options 1 and 5). In addition, clients should be instructed not to smoke while taking combined OCPs due to an increased risk of blood clots

Question 264

Drugs commonly associated with orthostatic hypotension include:

Answer 264

- Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin) - Antipsychotic medications (eg, olanzapine, risperidone) and antidepressants (eg, selective serotonin reuptake inhibitors) - Volume-depleting medications such as diuretics (eg, furosemide, hydrochlorothiazide) - Vasodilator medications (eg, nitroglycerine, hydralazine) - Narcotics (eg, morphine)

Question 265

terazosin

Answer 265

- alpha blocker - antihypertensive - an alpha-adrenergic blocker that can relieve urinary retention in clients with BPH. It relaxes the smooth muscle in the bladder neck and prostate gland; however, it also relaxes smooth muscle in the peripheral vasculature, which can cause orthostatic hypotension, syncope (blacking out), and falls. This is particularly common when the drug is started (first-dose hypotension) or when the dosage is increased. The serious effects can be avoided by instructing the client to take the medication at bedtime, change positions slowly when going from lying to standing, and avoid any medications that also increase smooth muscle relaxation (eg, phosphodiesterase-5 inhibitors [sildenafil or vardenafil] used to treat erectile dysfunction). Some clients may also experience ejaculatory dysfunction (decreased or absent ejaculation).

Question 266

rosiglitazone

Answer 266

(Avandia) - Thiazolidinedione - used to treat type 2 diabetes mellitus. - These agents improve insulin sensitivity but do not release excess insulin, leading to a low risk for hypoglycemia (similar to metformin). - These drugs can worsen heart failure by causing fluid retention and increase the risk of bladder cancer. Heart failure or volume overload is a contraindication to thiazolidinedione use. These medications also increase the risk of cardiovascular events such as myocardial infarction.

Question 267

pioglitazone

Answer 267

(Actos) - Thiazolidinedione - used to treat type 2 diabetes mellitus. - These agents improve insulin sensitivity but do not release excess insulin, leading to a low risk for hypoglycemia (similar to metformin). - These drugs can worsen heart failure by causing fluid retention and increase the risk of bladder cancer. Heart failure or volume overload is a contraindication to thiazolidinedione use. These medications also increase the risk of cardiovascular events such as myocardial infarction.

Question 268

Corticosteroid therapy and addisons disease

Answer 268

Corticosteroid therapy is the primary classification of drugs used to treat Addison's disease, an adrenocortical insufficiency. Signs and symptoms of infection should be reported to the PHCP immediately. Use of corticosteroids can cause immunosuppression. Infection can develop quickly and spread rapidly. Its anti-inflammatory effects may also mask signs of infection such as inflammation, redness, tenderness, heat, fever, and edema. In addition, physiological stress such as infection can trigger addisonian crisis, a life-threatening complication of Addison's disease. - Tachycardia, moon face, and weight gain are also side effects of long-term corticosteroid therapy; however, they are not as life-threatening as infection.

Question 269

Psyllium

Answer 269

Bulk-forming fiber supplement

Question 270

methylcellulose

Answer 270

Bulk-forming fiber supplement

Question 271

wheat dextrin

Answer 271

Bulk-forming fiber supplement

Question 272

mannitol

Answer 272

(Osmitrol) is an osmotic diuretic used to treat cerebral edema (increased intracranial pressure) and acute glaucoma. When administered, mannitol causes an increase in plasma oncotic pressure (similar to excess glucose) that draws free water from the extravascular space into the intravascular space, creating a volume expansion. This fluid, along with the drug, is excreted through the kidneys, thereby reducing cerebral edema and intracranial pressure. However, if a higher dose of mannitol is given or it accumulates (as in kidney disease), fluid overload that may cause life-threatening pulmonary edema results. An early sensitive indicator of fluid overload is new onset of crackles auscultated in the lungs. To prevent these complications, clients require frequent monitoring of serum osmolarity, input and output, serum electrolytes, and kidney function.

Question 273

albumin

Answer 273

may be given after paracentesis to prevent volume depletion in a client with ascitic cirrhosis.

Question 274

The recommended rates for an intermittent IV infusion of potassium chloride (KCl) are

Answer 274

no greater than 10 mEq (10 mmol) over 1 hour when infused through a peripheral line and no greater than 40 mEq/hr (40 mmol/hr) when infused through a central line (follow facility guidelines and policy). A too rapid infusion can lead to pain and irritation of the vein and postinfusion phlebitis. Contacting the health care provider to verify this prescription is the priority action.

Question 275

Sulfasalazine

Answer 275

(Azulfidine) contains sulfapyridine and aspirin (5-ASA) and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD). When the 5-ASA is combined with the sulfa preparation, the drug does not become absorbed until it reaches the colon. Dehydration is a risk with IBD as the client can have up to 20 diarrheal stools a day. The client usually does not feel thirsty until after there is a fluid volume deficit. Sulfa can crystallize in the kidney if the client is dehydrated. Normal urine specific gravity is 1.003-1.030. Elevated specific gravity can indicate concentrated urine and be a sign of dehydration (Azulfidine) is a sulfonamide (salicylate and sulfa antibiotic) and nonbiologic disease-modifying antirheumatic drug (DMARD) used for mild to moderate chronic inflammatory rheumatoid arthritis (RA) and inflammatory bowel disease (eg, ulcerative colitis). It inhibits the production of prostaglandin, a mediator in the body's inflammatory response. Most "sulfa" medications (eg, trimethoprim, sulfamethoxazole) share common side effects, including: - Crystalluria causing kidney injury – client should drink 8 glasses of water daily to maintain adequate urine output (eg, 1200-1500 mL/day) - Photosensitivity and risk for sunburn – client should avoid sun exposure and apply sunscreen - Folic acid deficiency (megaloblastic anemia and stomatitis) – client should eat folate-rich foods and take 1 mg/day folic acid supplement - Rarely life-threatening agranulocytosis (leukopenia) – client should be monitored for complete blood count at the start of therapy and report fever or sore throat immediately - Stevens-Johnson syndrome – client should stop the medicine if rash develops - Urine and skin can turn an orange-yellow color but will return to normal when the drug is discontinued. This is an expected finding.

Question 276

St. John's wort

Answer 276

is an herbal product commonly used by many clients to treat depression. However, it may interact with medications used to treat depression or other mood disorders, including tricyclic antidepressants, selective serotonin and/or norepinephrine receptor inhibitors (SSRIs/SNRIs), and monoamine oxidase inhibitors (MAOIs). Taking St. John's wort with these medications tends to increase side effects and could potentially lead to a dangerous condition called serotonin syndrome. Serotonin is a chemical produced by the body that is needed for the nerve cells and brain to function. Excessive serotonin causes symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, and seizures). Severe serotonin syndrome can be fatal if it is not treated.

Question 277

Phenazopyridine hydrochloride

Answer 277

(Pyridium) is a urinary analgesic prescribed to relieve the pain and burning associated with a urinary tract infection. The urine will turn bright red-orange while on this medication; other body fluids can be discolored as well. Because staining of underwear, clothing, bedding, and contact lenses can occur, the nurse should suggest that the client use sanitary napkins and wear eyeglasses while taking the medication. Phenazopyridine hydrochloride provides symptomatic relief but no antibiotic action, and so it is important that the client take a full course of antibiotics.

Question 278

Azathioprine

Answer 278

(Imuran) is an immunosuppressant drug that can cause bone marrow depression and increase the risk for infection. It is prescribed to treat autoimmune conditions such as inflammatory bowel disease and to prevent organ transplant rejection. Fatigue and nausea can be expected as minor adverse effects or may be associated with the disease. Leukopenia (white blood cell count <4,000/mm3) can be a severe adverse effect of the drug and should be reported to the health care provider before administering the medication.

Question 279

Colchicine

Answer 279

prescribed for clients with an acute attack of gout as it decreases the inflammation and pain associated with deposition of uric acid crystals in the joints

Question 280

cyclosporine

Answer 280

is an immunosuppressant prescribed to manage rheumatoid arthritis (RA) and psoriasis, and to prevent transplant rejection. This medication inhibits the normal immune response by interfering with T cell response, which slows the progression of certain autoimmune diseases. - Gastrointestinal side effects (diarrhea, abdominal pain, nausea and vomiting) are extremely common, reversible adverse effects of colchicine therapy - Clients taking cyclosporine have an increased risk for infection and are instructed to avoid large crowds (eg, concerts, movie theaters) and known sick contacts. - It can take 1-2 months for the full effect of therapy and relief of symptoms from autoimmune disease (eg, joint stiffness in RA, psoriasis symptoms) to occur. - This medication is for long-term use, and it is therefore important to monitor clients for adverse effects. The incidence of secondary malignancies (eg, skin cancer, lymphoma) is increased in these clients.

Question 281

mycophenolate

Answer 281

immunosuppressive medication given to transplant pts to prevent rejection

Question 282

Sodium polystyrene sulfonate retention enema

Answer 282

is a medicated enema administered to clients with high serum potassium levels. The resin in Kayexalate replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level. Kayexalate can also be given orally and is much more effective. Kayexalate can rarely be associated with intestinal necrosis.

Question 283

A neomycin enema

Answer 283

is a medicated enema that reduces the number of bacteria in the intestine in preparation for colon surgery.

Question 284

A barium enema

Answer 284

uses contrast medium (barium) administered rectally to visualize the colon using fluoroscopic x-ray.

Question 285

A fleet enema

Answer 285

relieves constipation by infusing a hypertonic solution into the bowel, pulling fluid into the colon and causing distension and then defecation.

Question 286

Montelukast

Answer 286

(Singulair) is a leukotriene (chemical mediator of inflammation) inhibitor and is not used to treat acute episodes. It is given orally in combination with beta agonists and corticosteroid inhalers (eg, fluticasone, budesonide) to provide long-term asthma control.

Question 287

Long-term therapy with a proton pump inhibitor (PPI) (eg, omeprazole, pantoprazole, esomeprazole)

Answer 287

may decrease the absorption of calcium and promote osteoporosis. A bone density test can assess if the client already has osteoporosis. Hospitalized clients also have an increased risk of diarrhea caused by Clostridium difficile. PPIs cause suppression of acid that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.

Question 288

esomeprazole

Answer 288

proton pump inhibitor - used for heartburn - suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach. In most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent stress ulcers from developing during surgery or a major illness. - Although evidence has shown that two-thirds of clients who receive PPIs do not need them, these medications are still widely prescribed in hospitalized clients. PPIs can be identified by their "-prazole" ending (eg, pantoprazole, lansoprazole, esomeprazole).

Question 289

Trazodone

Answer 289

(Oleptro), a serotonin modulator, is used to treat major depressive disorders. In addition to affecting serotonin levels, the drug blocks alpha and histamine (H1) receptors. Blockade of alpha receptors can cause orthostatic hypotension similar to that from other alpha blockers (eg, terazosin, tamsulosin) used to treat benign prostatic hyperplasia. Blockade of H1 receptors leads to sedation. Therefore, this drug is particularly effective in treating insomnia associated with depression. However, concurrent intake of other medications or substances that cause sedation can be detrimental; these include benzodiazepines (eg, alprazolam, lorazepam, diazepam), sedating antihistamines (eg, chlorpheniramine, hydroxyzine), and alcohol Priapism is a known serious side effect of trazodone. A client with an erection lasting several hours should go to the hospital.

Question 290

meds for death rattles

Answer 290

treated using anticholinergic medications to dry the client's secretions. Medications include atropine drops administered sublingually or a transdermal scopolamine patch.

Question 291

oseltamivir

Answer 291

(Tamiflu) antiviral for the flu given to clients who are within 48-72 hours of the onset of symptoms. These medications can shorten the duration of the illness by a few days.

Question 292

zanamivir

Answer 292

(Relenza) antiviral for the flu given to clients who are within 48-72 hours of the onset of symptoms. These medications can shorten the duration of the illness by a few days.

Question 293

Licorice root

Answer 293

is an herbal remedy sometimes used for gastrointestinal disorders such as stomach ulcers, heartburn, colitis, and chronic gastritis. Clients with heart disease or hypertension should be cautious about using licorice root. When used in combination with a diuretic such as hydrochlorothiazide, it can increase potassium loss, leading to hypokalemia. Hypokalemia can cause dangerous cardiac dysrhythmias. Thiazide diuretics are considered "potassium-wasting" diuretics, so this client is already at risk for hypokalemia. The addition of licorice root could potentiate the potassium loss. The nurse should discourage the client from using this herbal remedy and report the client's use to the PHCP.

Question 294

Aripiprazole

Answer 294

(Abilify) is an atypical antipsychotic that acts as a dopamine system stabilizer. It helps stabilize mood and control symptoms such as agitation and hallucinations in clients with dementia

Question 295

Cisplatin

Answer 295

is an antineoplastic drug that may cause kidney injury. Assessment of renal function includes laboratory values and urine output.

Question 296

diltiazem

Answer 296

calcium channel blocker - used to control ventricular rate - can decrease HR

Question 297

ibutilide

Answer 297

Antiarrhythmic medication | - may prolong the QT interval

Question 298

amiodarone

Answer 298

Antiarrhythmic medication | - may prolong the QT interval

Question 299

dabigatran

Answer 299

anticoagulant - reduce risk of blood clot (Pradaxa) is a thrombin inhibitor anticoagulant often prescribed to prevent thrombotic events in clients with atrial fibrillation, pulmonary embolism, and deep vein thrombosis. Clients taking dabigatran are at increased risk for bleeding and hemorrhage. Clients with signs of abnormal bleeding (eg, bruising; blood in the urine, sputum, vomitus, or stool; epistaxis; heavy menstrual bleeding [menorrhagia]) should be prioritized as prompt intervention and treatment may be required.

Question 300

trihexyphenidyl

Answer 300

Anticholinergic - commonly used to treat tremor in pts with parkinsons - However, in clients with benign prostatic hyperplasia or glaucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode

Question 301

fexofenadine

Answer 301

H1 receptor antagonist - decrease the inflammatory response by blocking histamine receptors. Histamine is released from mast cells during a type I (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic conjunctivitis, and hives)

Question 302

cetirizine

Answer 302

H1 receptor antagonist - decrease the inflammatory response by blocking histamine receptors. Histamine is released from mast cells during a type I (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic conjunctivitis, and hives)

Question 303

levocetirizine

Answer 303

H1 receptor antagonist - decrease the inflammatory response by blocking histamine receptors. Histamine is released from mast cells during a type I (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic conjunctivitis, and hives)

Question 304

St John's wort

Answer 304

an herbal supplement commonly used to treat depression and anxiety. Some clients with mild or moderate depression claim that its antidepressant effect is comparable to that of prescription medications. The herbal supplement mimics the action of selective serotonin reuptake inhibitors (SSRIs) by increasing available serotonin in the brain. Taken in combination with an SSRI (eg, sertraline, fluoxetine, citalopram, paroxetine), St John's wort may cause an excess of serotonin, resulting in serotonin syndrome, which is characterized by mental status changes, autonomic dysregulation, and neuromuscular hyperactivity.

Question 305

guaifenesin

Answer 305

Extended-release guaifenesin (Mucinex) is an expectorant medication that increases respiratory fluids and thins secretions to facilitate mobilization and expectoration. It is appropriate to prescribe in clients who have pneumonia with a productive cough and low-pitched wheezing (rhonchi)

Question 306

hydroxyzine

Answer 306

(Atarax) Histamine blocker

Question 307

Isotretinoin

Answer 307

(Accutane) decreases sebum secretion and is prescribed for severe, disfiguring nodular acne that has been unresponsive to other therapies, including antibiotics. It is a pregnancy category X drug and is known to cause serious birth defects if taken during pregnancy. Females prescribed isotretinoin must have 2 negative pregnancy tests before taking the medication. Also, 2 forms of contraception must have been in place for at least 1 month prior to starting isotretinoin, and these must be continued both during treatment and for 1 month after the medication is discontinued. Before refills can be obtained, enrollment in a risk management program is required to verify that pregnancy tests are negative and 2 forms of contraception are being used. Blood donation is also discouraged while on therapy and for 1 month afterward to ensure that pregnant women do not receive any donated blood. Side effects include birth defects, skin changes (eg, dry skin, skin fragility, cutaneous atrophy), and risk for increased intracranial pressure. Clients need to be instructed to avoid tetracycline, excess sun and tanning, and vitamin A supplements. Women of child-bearing age should use 2 forms of contraception to prevent pregnancy.

Question 308

Carbamazepine

Answer 308

(Tegretol)

Question 309

theophylline

Answer 309

bronchodilator with a low therapeutic index and a narrow therapeutic range (10-20 mcg/mL). The serum level should be monitored frequently to avoid severe adverse effects. Toxicity is likely to occur at levels >20 mcg/mL. Individual titration is based on peak serum theophylline levels, so it is necessary to draw a blood level 30 minutes after dosing. Theophylline can cause seizures and life-threatening arrhythmias. Toxicity is usually due to intentional overdose or concurrent intake of medications that increase serum theophylline levels. Cimetidine and ciprofloxacin can dramatically increase serum theophylline levels (>80%). Therefore, they should not be used in these clients.

Question 310

terbinafine

Answer 310

(Lamisil) Antifungal cream - preferred treatment for ringworm and is applied to infected areas twice a day. It may take 1-4 weeks to complete treatment depending on infection severity

Question 311

Regular insulin

Answer 311

is short-acting and peaks 2-5 hours after administration. The onset of regular insulin is 30 minutes-1 hour with duration of 5-8 hours

Question 312

ciprofloxacin

Answer 312

``` fluoroquinolone - used for UTI - places clients at increased risk for tendinitis and tendon rupture that most often occur in the Achilles tendon. This class of antibiotics carries a black box warning about this risk. The Food and Drug Administration recommends that at the first sign of tendon pain or swelling, clients should stop taking the fluoroquinolone, abstain from moving the affected area, and contact their HCP promptly for further evaluation and a change of antibiotic. ```

Question 313

moxifloxacin

Answer 313

fluoroquinolone - used for UTI

Question 314

norfloxacin

Answer 314

fluoroquinolone - used for UTI

Question 315

ofloxacin

Answer 315

fluoroquinolone - used for UTI

Question 316

famciclovir

Answer 316

commonly used to treat herpes infection as they shorten the duration and severity of active lesions

Question 317

valacyclovir

Answer 317

commonly used to treat herpes infection as they shorten the duration and severity of active lesions

Question 318

Acyclovir

Answer 318

(Zovirax) commonly used to treat herpes infection as they shorten the duration and severity of active lesions

Question 319

Fluticasone/salmeterol

Answer 319

(Advair) is a combination drug containing a corticosteroid (fluticasone) and a bronchodilator (salmeterol). Salmeterol is a long-acting inhaled β2-adrenergic agonist that promotes relaxation of the bronchial smooth muscles over 12 hours. Fluticasone decreases inflammation. This medication is used as part of the treatment plan for prevention and long-term control of asthma. Client instructions include: - After inhalation, rinse the mouth with water without swallowing to reduce the risk of oral/esophageal candidiasis - Avoid smoking and using tobacco products - Receive the pneumococcal and influenza vaccines if there is a risk for infection

Question 320

risperidone

Answer 320

(Risperdal) Atypical (second-generation) antipsychotic medications are used in the treatment of schizophrenia, bipolar disorder, and other mental health disorders. The nurse should teach clients and caregivers about potential side effects of antipsychotic medications. Key teaching points include: - Extrapyramidal symptoms (EPS) include akathisia (restlessness, fidgeting) and Parkinsonism (tremors, shuffling gait). These specific symptoms are important to watch for, as EPS is easily mistaken for agitation or negative schizophrenic symptoms. - Fever and muscle rigidity may indicate neuroleptic malignant syndrome, a potentially fatal condition requiring emergent intervention - Clients may experience anticholinergic effects (eg, dry mouth, constipation). - Clients should change positions slowly to prevent orthostatic hypotension - Sedating effects (eg, drowsiness, hypersomnia [excessive sleeping]) are common - Symptoms are evaluated on an individual basis, and most minor symptoms can be managed with a decrease in dosage or change in medication. The health care provider may prescribe medications to treat EPS (eg, benzodiazepines, diphenhydramine).

Question 321

quetiapine

Answer 321

(Seroquel) Atypical (second-generation) antipsychotic medications are used in the treatment of schizophrenia, bipolar disorder, and other mental health disorders. The nurse should teach clients and caregivers about potential side effects of antipsychotic medications. Key teaching points include: - Extrapyramidal symptoms (EPS) include akathisia (restlessness, fidgeting) and Parkinsonism (tremors, shuffling gait). These specific symptoms are important to watch for, as EPS is easily mistaken for agitation or negative schizophrenic symptoms. - Fever and muscle rigidity may indicate neuroleptic malignant syndrome, a potentially fatal condition requiring emergent intervention - Clients may experience anticholinergic effects (eg, dry mouth, constipation). - Clients should change positions slowly to prevent orthostatic hypotension - Sedating effects (eg, drowsiness, hypersomnia [excessive sleeping]) are common - Symptoms are evaluated on an individual basis, and most minor symptoms can be managed with a decrease in dosage or change in medication. The health care provider may prescribe medications to treat EPS (eg, benzodiazepines, diphenhydramine).

Question 322

olanzapine

Answer 322

(Zyprexa) Atypical (second-generation) antipsychotic medications are used in the treatment of schizophrenia, bipolar disorder, and other mental health disorders. - considered standard treatment to control violent behavior in the client with schizophrenia The nurse should teach clients and caregivers about potential side effects of antipsychotic medications. Key teaching points include: - Extrapyramidal symptoms (EPS) include akathisia (restlessness, fidgeting) and Parkinsonism (tremors, shuffling gait). These specific symptoms are important to watch for, as EPS is easily mistaken for agitation or negative schizophrenic symptoms. - Fever and muscle rigidity may indicate neuroleptic malignant syndrome, a potentially fatal condition requiring emergent intervention - Clients may experience anticholinergic effects (eg, dry mouth, constipation). - Clients should change positions slowly to prevent orthostatic hypotension - Sedating effects (eg, drowsiness, hypersomnia [excessive sleeping]) are common - Symptoms are evaluated on an individual basis, and most minor symptoms can be managed with a decrease in dosage or change in medication. The health care provider may prescribe medications to treat EPS (eg, benzodiazepines, diphenhydramine).

Question 323

mixing regular and NPH insulin

Answer 323

NPH insulin and regular insulin can be safely mixed and administered as a single injection. Regular insulin should be drawn up before intermediate-acting insulin to avoid contaminating multidose insulin vials (mnemonic – RN: Regular before NPH).

Question 324

Amphotericin B

Answer 324

is an antifungal medication used to treat systemic fungal infections. It is commonly associated with severe adverse effects, including hypotension, fever, chills, and nephrotoxicity. Due to the similarity between the adverse effects of amphotericin B and the symptoms of a blood transfusion reaction, the nurse's best action is to complete the blood transfusion and allow one hour of observation before initiating amphotericin B

Question 325

methadone

Answer 325

given to pts going through withdraws to alleviate discomfort is a potent narcotic with a longer half-life than its duration of action due to its lipophilic properties. The risk for overdose exists as clients can inadvertently take too many tablets for additional pain relief even though fat cells will continue to release high amounts of the drug into circulation. Early signs of toxicity include nausea/vomiting and lethargy. A client who falls asleep with stimulation (ie, is obtunded) requires additional observation/monitoring. Sedation precedes respiratory depression, a life-threatening complication of severe toxicity

Question 326

Chlorpheniramine

Answer 326

(ChlorTrimeton) is a sedating histamine H1 antagonist used to treat allergy symptoms. Increased central nervous system effects (eg, drowsiness, dizziness) may occur due to its reduced clearance in the elderly

Question 327

Nesiritide

Answer 327

vasodilator - decrease preload so improves cardiac output and decreasing pulmonary congestion,

Question 328

hydromorphone

Answer 328

(dilaudid) - 5-10 times the strength of morphine | - typical max dose 2 mg

Question 329

Zolpidem

Answer 329

(Ambien) is a hypnotic medication that induces sleep for clients with sleep disturbances (eg, acute mania).

Question 330

cyanocobalamin

Answer 330

for vitamin B12 deficiency are usually administered every 4 weeks

Question 331

long-term corticosteroid replacement

Answer 331

Corticosteroids are the primary drugs used to treat Addison's disease Clients taking long-term corticosteroid replacement should be taught the following: - Do not discontinue glucocorticoid therapy abruptly. Abrupt discontinuation could lead to addisonian crisis, a life-threatening complication. - Report any signs and symptoms of infection to the HCP immediately. Corticosteroid use can cause immunosuppression, and infection can develop quickly and spread rapidly. Corticosteroids' anti-inflammatory effects may also mask signs of infection such as inflammation, redness, tenderness, heat, fever, and edema. - Stay attuned to signs and symptoms of stress and increase dose of corticosteroid during times of stress. A stress response (surgery, trauma) can cause a sudden decrease in cortisol levels, triggering addisonian crisis. - A side effect of corticosteroid therapy is hyperglycemia. Report signs of hyperglycemia, including increased urine, hunger, and thirst. Clients with diabetes mellitus must be vigilant in checking blood glucose levels. - Corticosteroids are catabolic to bone (osteoporosis) and muscle (muscle weakness). A diet high in calcium (at least 1500 mg/day) and protein (1.5 g/kg/day) but low in fat and simple carbohydrates is recommended. - Cataracts are a side effect of corticosteroids, particularly glucocorticoid therapy. Make an appointment with an optometrist yearly to assess for cataracts. - Corticosteroid medications can cause gastric irritation and should not be taken on an empty stomach. - Recognize signs and symptoms of Cushing syndrome and report to the PHCP. - Develop a regular HCP-approved exercise program.

Question 332

adalimumab

Answer 332

tumor necrosis factor (TNF) inhibitor that suppresses the inflammatory response in autoimmune diseases such as rheumatoid arthritis, Crohn disease, and psoriasis. Due to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection. A client with current, recent, or chronic infection should not take a TNF inhibitor pts should also have a TB test before starting treatment

Question 333

ranitidine

Answer 333

histamine-2 antagonist

Question 334

tolnaftate

Answer 334

topical antifungal

Question 335

haloprogin

Answer 335

topical antifungal

Question 336

clotrimazole

Answer 336

topical antifungal

Question 337

propranolol

Answer 337

beta blocker nonselective beta-blocker that inhibits beta1 (heart) and beta2 (bronchial) receptors. It is used for many indications (eg, essential tremor) in addition to blood pressure control. Blood pressure decreases secondary to a decrease in heart rate. Bronchoconstriction may occur due to the effect on the beta2 receptors. The presence of wheezing in a client taking propranolol may indicate that bronchoconstriction or bronchospasm is occurring. The nurse should assess for any history of asthma or respiratory problems with this client and notify the health care provider Beta-adrenergic blockers are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperthyroidism in which excessive thyroid hormones are released into the circulation. Beta blockers block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism

Question 338

promethazine

Answer 338

(Phenergan) antihistamine

Question 339

ibuprofen

Answer 339

Nonsteroidal anti-inflammatory drug (NSAID) - inhibit prostaglandin synthesis and can be taken to decrease pain and inflammation or to reduce fever. NSAIDs are pregnancy category C in the first and second trimesters and pregnancy category D in the third trimester. NSAIDs must be avoided during the third trimester due to the risk of causing premature closure of the ductus arteriosus in the fetus. During the first and second trimesters, NSAIDs should be taken only if benefits outweigh risks and under the supervision of a health care provider (HCP). All NSAIDs are associated with the following: - Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food. - Kidney injury - long-term use is associated with kidney injury - Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension - Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding.

Question 340

Acetaminophen

Answer 340

(pregnancy category B) is a common pain reliever and/or fever reducer used during pregnancy. Acetaminophen intake should not exceed 4 g per day, including any over-the-counter or prescription combination medications that contain acetaminophen

Question 341

alcoholic pts should be given what first

Answer 341

Clients with alcoholism can have hypoglycemia. They can also have thiamine (vitamin B1) deficiency related to poor nutrient intake (a healthy diet contains enough thiamine) and alcohol-induced suppression of thiamine absorption. Thiamine deficiency can result in Wernicke encephalopathy (WE). Untreated WE can lead to death or neurologic morbidity (Korsakoff psychosis). In the setting of alcoholism, administered glucose is oxidized by using all the existing thiamine in the body; this can worsen thiamine deficiency, which in turn can precipitate the development of WE in a previously unaffected individual. Because the signs of alcohol intoxication and WE are similar, all intoxicated clients should be given IV thiamine before or with IV glucose

Question 342

haloperidol

Answer 342

(Haldol) considered standard treatment to control violent behavior in the client with schizophrenia

Question 343

Propofol

Answer 343

(Diprivan) is considered standard treatment to sedate the client receiving mechanical ventilation to provide ventilator control, prevent accidental extubation, and promote comfort

Question 344

valsartan/sacubitril

Answer 344

Entresto is an angiotensin receptor-neprilysin inhibitor that is prescribed to clients with heart failure to vasodilate the vessels and inhibit the renin-angiotensin-aldosterone system (RAAS). It has been shown to reduce hospitalizations and mortality rates in clients with heart failure. Side effects include hypotension hyperkalemia, dizziness, cough, and a decrease in renal function. This medication can also cause angioedema, a life threatening reaction that can impede the airway. Tongue thickness may be an indication that the client is experiencing a mild case of angioedema that could potentially get worse over time. The nurse should report this finding immediately to the healthcare provider, who will likely discontinue the medication. Valsartan/sacubitril should not be prescribed to any client with a history of angioedema. Incidence is higher in African American clients and those who have had a previous episode of angioedema

Question 345

meds that affect asthma

Answer 345

Two groups of commonly used drugs, nonsteroidal anti-inflammatory drugs and beta-adrenergic antagonists (beta blockers), have the potential to cause problems for clients with asthma. Ibuprofen (Motrin) and aspirin are common over-the-counter anti-inflammatory drugs that are effective in relieving pain, discomfort, and fever. About 10%-20% of asthmatics are sensitive to these medications and can experience severe bronchospasm after ingestion. This is prevalent in clients with nasal polyposis.

Question 346

Fondaparinux

Answer 346

(Arixtra), unfractionated heparin, and low molecular weight heparin (eg, enoxaparin, dalteparin) are anticoagulants commonly used for deep vein thrombosis and pulmonary embolism prophylaxis after hip/knee replacement or abdominal surgery. However, fondaparinux is not administered until more than 6 hours after any surgery, and anticoagulants are not given while an epidural catheter is in place. Fondaparinux is associated with epidural hematoma. Any bleeding in the tight epidural space, which does not expand, could result in spinal cord compression. Signs of epidural spinal hematoma can include severe back pain and paralysis

Question 347

verapamil

Answer 347

calcium channel blocker sometimes used for the prevention of migraines. - Calcium channel blockers may decrease neurovascular inflammation, thereby reducing the occurrence of migraines. Because verapamil affects the cardiac system, the pulse rate should be checked prior to administration due to possible bradycardia - The medication should be held, and the client's health care provider contacted, if the heart rate is <60/min. Clients should also have periodic blood pressure evaluations to ensure that hypotension is not occurring. - Intake of grapefruit (including grapefruit juice) should be avoided, as it can increase serum levels of verapamil by reducing hepatic clearance of the drug - Increasing fluids and fiber helps to prevent constipation, a common side effect of most calcium channel blockers, particularly verapamil

Question 348

timolol

Answer 348

beta blocker | - can decrease HR

Question 349

isocarboxazid

Answer 349

(Marplan) Monoamine oxidase inhibitor (MAOI) - prescribed for treatment-resistant and atypical depression. Clients taking MAOIs must avoid high-tyraminefoods to prevent life-threatening hypertensive crisis. Foods and beverages to avoid include aged cheeses (eg, most cheeses except for cream and cottage cheese); protein-rich foods; and foods that have been processed (eg, hot dogs), pickled, fermented (eg, sauerkraut, pepperoni), or smoked (eg, smoked salmon). Most fruits and vegetables (eg, salad, broccoli) contain little to no tyramine

Question 350

Diclofenac

Answer 350

nonsteroidal anti-inflammatory drug (NSAID) prescribed to treat pain from inflammatory or musculoskeletal disorders, dysmenorrhea, or migraines. NSAIDs (ibuprofen, naproxen) increase the risk of cardiovascular thrombotic events (eg, myocardial infarction, stroke) and gastrointestinal inflammation and ulcers. The lowest effective dose should be used for the shortest necessary duration. Concurrent use with aspirin or alcohol increases the risk for gastrointestinal bleeding.

Question 351

When administering IV vancomycin, the nurse should assess for and work to prevent possible complications by performing the following:

Answer 351

- Draw the prescribed trough level prior to administration. Therapeutic vancomycin levels range from 10-20 mg/L for hemodynamically stable clients. Adverse effects of vancomycin toxicity include nephrotoxicity (eg, elevated creatinine levels) and ototoxicity (eg, hearing loss, vertigo, tinnitus). - Infuse medication over at least 60 minutes (≤10 mg/min). Faster rates increase the likelihood of complications - Monitor blood pressure during the infusion. Hypotension is a possible adverse effect - Assess for hypersensitivity. Red man syndrome is a nonallergic histamine reaction characterized by sudden onset of severe hypotension, flushing, and/or maculopapular rash of the face, neck, chest, and upper extremities - Monitor for anaphylaxis (eg, rash, pruritus, laryngeal edema, wheezing). - Observe IV site every 30 minutes for pain, redness, or swelling. Vancomycin is a vesicant and may cause thrombophlebitis or, if extravasation occurs, tissue necrosis. Administration using a central venous catheter is preferred; however, a peripheral IV may be used for short-term therapy

Question 352

Activated charcoal

Answer 352

n important treatment in early acetylsalicylic acid (ASA) toxicity; it is recommended for gastrointestinal decontamination in clients with clinical signs of ASA poisoning (disorientation, vomiting, hyperpnea, diaphoresis, restlessness) as well as in those who are asymptomatic. Activated charcoal binds to available salicylates, thus limiting further absorption in the small intestine and enhancing elimination.

Question 353

Rituximab

Answer 353

(Rituxan) is a monoclonal antibody (end in -mab) that affects the lymphocytes. It is commonly prescribed to treat certain forms of cancer (eg, lymphoma) and autoimmune diseases (eg, lupus). Like many monoclonal antibodies, rituximab can produce a powerful immune response (eg, bronchospasm, dyspnea, tachypnea, hypotension, angioedema) (Option 3). The nurse should closely monitor the client during and after the infusion. If life-threatening symptoms develop, the nurse should stop the infusion and immediately notify the health care provider. The symptoms will be treated (eg, corticosteroids) and, when resolved, the infusion is usually restarted at a slower rate.

Question 354

Oral iron supplements

Answer 354

At birth, a newborn will have enough iron (received during the last trimester of pregnancy) to last until approximately age 4 months. After this age, formula-fed infants usually receive adequate iron intake from iron-fortified formula, whereas breastfed infants may require supplementation until they begin eating iron-rich foods. Oral iron supplements should be given on an empty stomach between meals for best absorption. If gastric irritation occurs, iron may be given with meals; however, this will decrease absorption. If the child is old enough, the supplements should be offered with citrus fruit juice as vitamin C will increase absorption. Milk products and antacids also decrease the absorption of oral iron and should be avoided for 2 hours following administration

Question 355

edoxaban

Answer 355

anticoagulant

Question 356

sotalol

Answer 356

Antiarrhythmic | - may prolong the QT interval

Question 357

dofetilide

Answer 357

Antiarrhythmic | - may prolong the QT interval

Question 358

Detemir

Answer 358

(Levemir), a long-acting (basal) insulin, is prescribed once daily in the evening or twice daily in divided doses. - it is administered to control blood sugar between meals and overnight, in addition to mealtime (bolus) insulin