Wiki 4

Question 1

Acetaminophen (Tylenol) is an effective analgesic for discomfort associated with headache, and musculoskeletal pain. This drug works by prostaglandin inhibition in the CNS and blocks generation of pain impulses in the peripheral tissue but has no anti-inflammatory activity. What else is it used for?

Answer 1

fever reduction

Question 2

Ibuprofen (Advil) is used on to relieve pain and

Answer 2

inflammation

Question 3

What is administered on arrival to the emergency department to those patients experiencing an acute MI?

Answer 3

aspirin

Question 4

NSAIDs can put patients at risk for what serious adverse effects?

Answer 4

can cause gastrointestinal bleeding, hepatotoxicity, hives, rash, pruritis, facial swelling, nephrotoxicity and blood dyscrasias

Question 5

The client presents to the outpatient clinic with a chief complaint of insomnia. The client’s medical history includes Alcohol dependence, Peptic Ulcer Disease, and Urinary Tract Infections. The client is allergic to antihistamines and Nonsteroidal anti-inflammatory drugs (NSAIDS).

What prescription medication is best to use for this client’s insomnia?

Answer 5

trazodone

Question 6

The nurse administered Hydromorphone (Dilaudid) 2mg IV to the hospitalized client 30 minutes ago. When the nurse enters the room to complete a pain recheck the client is noted to have blue lips, heart rate is 45, and the client is making gurgling noises.

What is the priority nursing intervention for this client?

Answer 6

Blue lips, bradycardia, and gurgling are signs of an opioid overdose in this case of dilaudid. Therefore give naloxone (narcan) to reverse the effects and put the head of the bed in Fowler position if not contraindicated. Check their vital signs afterwards to make sure they are breathing properly.

Question 7

The nurse is completing a home medication reconciliation on the client in the Emergency Department. The client reports taking the following medications daily:

Diphenhydramine 25mg P.O. TID PRN seasonal allergy symptoms
Acetaminophen (Tylenol) 3 grams P.O. BID
Omeprazole (Prilosec) 20mg P.O. Qday

Which home medication is concerning? 
Why is it concerning?

Answer 7

Acetaminophen

This patient is ingesting a total of 6 grams of acetaminophen per day, and the maximum daily recommendation is 4g per day for an adult. The overdose can lead to hepatotoxicity which can be life threatening.

Question 8

Administration of opiate agonists causes primary effects on the CNS including

Answer 8

analgesic pain relief effects, sedation, drowsiness, respiratory depression, euphoria, and constricted pupils

Question 9

What common adverse effects of opiate agonists could impact patient safety?

Answer 9

Lightheadedness, dizziness, sedation, confusion, disorientation, addiction, withdrawal, abuse, dependence, orthostatic hypotension

Question 10

What are early signs of opiate withdrawal? What intensifies over the next24 hours?

Answer 10

Early signs of opiate withdrawal are restlessness, diaphoresis, piloerection, lacrimation, runny nose and mydriasis. Over the next 24 hours, these early signs intensify. Muscular spasms, aching in the back, abdomen and legs, hot and cold flashes, insomnia, nausea, vomiting and diarrhea, severe sneezing and increases in body temperature, blood pressure, and respiratory rate and heart rate all may occur.

Question 11

Which phase of pharmacokinetics is dependent on the route of administration?

Answer 11

absorption

Question 12

If a patient has a history of liver disease which phase of pharmacokinetics is most effected?

Answer 12

metabolism

Question 13

What is the desired therapeutic outcome when taking a benzodiazepine?

Answer 13

Decreased levels of anxiety to a managable level, produce mild sedation, to be used short term for sleep and also provide preoperative sedation with amnesia.

Question 14

What is a serious adverse effect from excessive use of a benzodiazepine?

Answer 14

Physical and psychological dependence, leading to possible withdrawl which includes symptoms like anxiety, delirium, and siezures. Can also result in overdose or death.

Question 15

What medications fall under the benzodiazepine classification?

Answer 15

Alprazolam(Xanax), Diazepam(Valium)

Question 16

What type of device might a patient with sleep apnea use every night?

Answer 16

CPAP (Continuous Positive Air Pressure)

Question 17

The presence of food, particularly food with a high fat content can slow the absorption of what medication?

Answer 17

zolpidem, zaleplon, eszopiclone, and ramelteon

Question 18

What would be included in good sleep hygiene techniques?

Answer 18

Consistent wake/sleep schedule, relaxing bedtime routine, avoid tv/blue light (phone) 30-60 min. before bedtime, avoid caffeine and alcohol after 4pm, use the bed for sleep and sex only, avoid large meal before bedtime, dim lights 30-60 minutes before bedtime, cool bedroom down to 65 degrees

Question 19

What antidepressant is prescribed in low dosages to assist patients with getting to sleep?

Answer 19

Trazodone, Remeron, and Doxepin

Question 20

GABA Receptor Agonists such as ________ work similar to benzodiazepine but with have less withdrawal symptoms.

Answer 20

Zolpidem(Ambien)

Question 21

What does the nurse do during the assessment phase of the nursing process?

Answer 21

The nurse will collect subjective and objective data, identify the patient’s actual or potential health problems, and analyze the assessment data

Question 22

If a patient has a history of kidney disease which phase of pharmacokinetics is most effected?

Answer 22

Drug Excretion

Question 23

Carbonic Anhydrase Inhibitors like dorzolamide (Trusopt) reduce intraocular pressure by

Answer 23

decreasing the production of aqueous humor

Question 24

What drug classification is used to lower intraocular pressure by increasing the outflow of aqueous humor and produces mydriasis for ophthalmic examinations?

Answer 24

Alpha-Adrenergic agents

Question 25

Beta-Adrenergic Blockers like timolol maleate (Timoptic) can have what serious cardiovascular adverse effects?

Answer 25

Bradycardia, dysrthythmias, hypotension

Question 26

latanoprost (Xalatan) is a __________ that reduces IOP by increasing the outflow of aqueous humor

Answer 26

Prostglandin Analog (classification)

Question 27

_________is an eye disease characterized by abnormally elevated intraocular pressure (IOP), which may result from excessive production of the ___________ or from diminished ocular fluid outflow. Increased pressure, if persistent and sufficiently elevated, may lead to permanent ______.

Answer 27

glaucoma

aqueous humor

blindness

Question 28

The elderly client is diagnosed with seasonal allergies, open-angle glaucoma, osteoarthritis, and urinary incontinence at the Primary Care appointment. The client has a history of taking the following medications:
Ibuprofen (Motrin)
Loratidine (Claritin)
Oxybutynin (Ditropan XL)
Dorzolamide (Trusopt)

Which of these medications should be avoided in this client?

Why?

Answer 28

Oxybutynin (Ditropan XL)

can increase intraoccular pressure, which can worsen symptoms of glaucome and even lead to damaging the optic nerve

Question 29

The nurse is reviewing the client’s home medication list which includes the following medications:
Tiotropium (Spiriva Respimat) 1.25 mcg inhaled BID
Salmeterol (Serevent Diskus) 50mcg inhaled Q12 hours
Albuterol (Proventil-HFA) 90 mcg two puffs inhaled Q4-6 hours PRN bronchospasm.

What is the client’s medical diagnosis?

Answer 29

COPD (chronic obstructive pulmonary disease) or asthma