Advanced Pharmacology Final - Practice Quiz Questions

Escitalopram may cause serious, potentially fatal reactions when used with _______________. (select all that apply) ANS - Duloxetine, amitriptilyne, sertraline, St. John's Wort Mixing two serotonin agents can cause serotonin syndrome. The therapeutic effects of imipramine develop over _____________. ANS - Several weeks The FDA-approved indications for fluoxetine include: (select all that apply) ANS - Obsessive compulsive disorder, major depressive disorder, bulimia nervosa Taking food with buspirone alters absorption. ANS - False Advanced Pharmacology Final - Practice Quiz Questions May be taken with food to minimize gastric irritation Venlafaxine is extensively metabolized on first pass through the ___________. ANS - Liver Signs and symptoms of lithium toxicity include: (select all that apply) ANS - Slurred speech, drowsiness Valproate acid has FDA-approved indications for: (select all that apply) ANS - Acute mania, simple and complex absence seizures, prevention of migraine headaches Atomoxetine selectively ____________ the presynaptic reuptake of norepinephrine resulting in a(n) ________________ attention span. ANS - Inhibits, improved Phenelzine does not need to be discontinued several days before elective surgery that requires anesthesia. ANS - False Bupropion can be used for smoking cessation. ANS - True Methylphenidate is not effective for narcoleptic patients. ANS - False Clozapine may cause: (select all that apply) ANS - Syncope, orthostatic hypotension, cardiac arrest Causes bradycardia which could lead to syncope and cardiac arrest Administering risperidone with levodopa is contraindicated. ANS - True It decreases the effects of levodopa The ___________ form of ziprasidone is frequently used for control of acutely agitated patients. ANS - Intramuscular (IM) Anticonvulsants are frequently used as mood stabilizers for the treatment of mania and bipolar spectrum disorders because they: ANS - Reduce synaptic kindling A patient was started on fluoxetine for depression 3 days ago. She now complains that it "doesn't help" and refuses to take it. Understanding the psychopharmacology, the nurse's best first action is to: ANS - Discuss with the patient that these types of medications often take several weeks before seeing the results. Which of the following is a common side effect of both first- and second-generation antipsychotic drugs? (select all that apply) ANS - Extrapyramidal side effects such as pseudo-parkinsonism or acute dystonia, neuroleptic malignant syndrome, excessive sedation A male patient who is taking the second-generation antipsychotic reports to the nurse that he has observed a clear fluid leaking from his right nipple for the past month. The nurse's best initial intervention is: ANS - Inform the patient that this could be a side effect of the medication The physician discusses the appropriateness of prescribing a serotonin/norepinephrine reuptake inhibitor (SNRI) for a patient. Which of the following medications are in this category? ANS - Venlafaxine and duloxetine A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse should counsel the patient about which of the following possible side effects, among others? ANS - Fever, sweating, agitation, rapid heartbeat A nurse counsels a patient who has been prescribed a monoamine oxidase inhibitor (MAOI) to treat depression to avoid foods containing tyramine. Which of the following foods should the patient avoid? (select all that apply) ANS - Yogurt, tofu, pepperoni A patient with severe kidney disease is started on lithium by a new resident. As the nurse on duty your best initial response would be to: ANS - Contact the resident to remind him that the client has kidney disease and lithium is contraindicated Which of the following is generally true of medications used to treat anxiety disorders? ANS - Just as with depression, the most common medications prescribed are serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). For which one of the following types of drugs is the consumption of grapefruit juice contraindicated? ANS - Second-generation antipsychotics Psychopharmaceutical agents are prescribed for individuals with substance use disorders for all of the following reasons except: ANS - To elevate the patient's mood in a manner comparable to the action of the misused substance A patient has been prescribed disulfiram. The nurse would most appropriately counsel the patient about which of the following? ANS - A toxic reaction if alcohol is consumed When a patient is prescribed risperidone for schizoaffective disorder, the nurse must alert the patient to the potential for neuroleptic malignant syndrome. Which of the following would be accurate information to give the patient? ANS - Neuroleptic malignant syndrome is potentially fatal. It usually occurs during the first 2 weeks after starting an antipsychotic drug or increasing the dose and is characterized by high fever, muscle stiffness, paranoia, sweating, and large changes in blood pressure. A client with depression is taking phenelzine. The nurse advises the client to avoid consuming which foods while taking the medication ANS - Yogurt Methylphenidate is a CNS stimulant and is the drug of choice for individuals with attention-deficit/hyperactivity disorder (ADHD). The desired effects of methylphenidate may be noted as: ANS - Increased attention span and concentration The risk of experiencing serotonin syndrome when selective serotonin reuptake inhibitors (SSRIs) are given with monoamine oxidase inhibitors (MAOIs) such as phenelzine. Serotonin syndrome is best characterized in which of the following? ANS - Muscle rigidity and high fever A 19-year-old female client with depression who has been taking amitriptyline for three weeks returns to the clinic for a follow-up. The nurse anticipates the possibility of observing which of the following symptoms? ANS - Suicidal thoughts A newly admitted client has started taking bupropion. The nurse understands which of the following side effects that would indicate an overdose of the medication? ANS - Seizure A client taking lithium carbonate started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium serum level is 2 mEq/L. The nurse interprets this value as: ANS - Toxic level Which of the following symptoms is a sign of mild lithium toxicity: ANS - Course tremor and lethargy A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue. The nurse determines that the client is experiencing? ANS - Tardive dyskinesia A client with schizophrenia has been started on medication therapy with clozapine. A nurse assesses the results of which laboratory study to monitor for adverse effect related to this medication? ANS - White blood cell Methylphenidate is prescribed to an 8-year-old child for the treatment of attention-deficit/hyperactivity disorder (ADHD). The nurse plans to monitor which of the following during the medication therapy? ANS - Height and weight Can cause slow growth and reduced appetite A client who has been taking buspirone for two months returns to the clinic for a follow-up. The nurse determines that the medication is effective if there is an absent display of... ANS - Feelings of panic, fear, and uneasiness Your patient is taking the antipsychotic medications clozapine and divalproex sodium (Depakote), both of which can contribute to weight gain. For what should this patient be carefully monitored? ANS - Increased blood glucose Nurse Trini knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD): ANS - Fluvoxamine and clomipramine A patient diagnosed with schizophrenia has taken thiothixene 5 mg/day for 4 years with good symptom control. Today, the patient is admitted with paranoia and auditory hallucinations. The nurse should determine if the patient's symptoms are related to: ANS - Not taking the drug as prescribed When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for extrapyramidal side effects (EPSEs) particularly: ANS - Akathisia Nortriptyline was prescribed for a 68-year-old patient diagnosed with depression and insomnia. Benefits specific to use of nortriptyline would include: ANS - Improved sleep pattern A patient with depression has taken a selective serotonin reuptake inhibitors (SSRIs) for 1 month. The nurse should use direct questions to evaluate which potential side effect? ANS - Sexual dysfunction A tricyclic antidepressant (TCA) is prescribed for a patient newly diagnosed with depression. What information should be included in patient teaching? ANS - It might be 2 weeks or more before you notice the effects of this medicine Patients taking tricyclic antidepressants (TCAs) exhibit more side effects than patients taking selective serotonin reuptake inhibitors (SSRIs), because TCAs: ANS - Inhibit reuptake of norepinephrine and serotonin Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of: ANS - Sodium Select the accurate information about the pharmacokinetics of lithium. ANS - Excreted by the kidneys A patient with rapid-cycling bipolar disorder is not responding to lithium therapy. At the next multidisciplinary team meeting, the nurse should point out that many rapid-cycling bipolar patients have been effectively treated using: ANS - Divalproex A patient diagnosed with mania begins lithium therapy on October 1. What is the earliest date a nurse can expect to see clinical improvement in the patient's condition? ANS - October 8 A patient started diazepam (Valium) 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. This phenomenon results from: ANS - Tolerance A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's priority action? ANS - Begin seizure precautions Which patient has the greatest risk for overdose with a benzodiazepine? A patient who: ANS - Combines the drug with alcohol Most drugs used to treat Alzheimer's disease affect: ANS - Cholinergic pathways, enzymes, and receptors Mr. Robbins is placed on quetiapine, which has the potential side effects of elevating cholesterol. Which laboratory test should you monitor related to this side effect? ANS - Lipid profile Singer Michael Jackson allegedly abused alprazolam and propofol, an anesthetic. Which inference applies? ANS - Potentially lethal sedation and CNS depression would be expected with this drug combination Monoamine oxidase inhibitors (MAOIs) can cause numbness, prickling, or tingling feelings, which are called: ANS - Paresthesias The waiting time between stopping a monoamine oxidase inhibitor (MAOI) and starting a selective serotonin reuptake inhibitor (SSRI) is which of the following? ANS - At least two weeks An acutely manic patient is started on divalproex. The experienced nurse understands valproate acid can be measured: ANS - Through a serum blood level Mr. Jones, a client of yours is on a regimen of warfarin (Coumadin) because of a venous thrombosis (blood clot) which developed following his orthopedic surgery. Which of the following blood tests will he likely need as he is monitored during his treatment? ANS - Prothrombin time/INR Anticoagulants are used to ANS - Prevent the formation of blood clots Thrombolytic drugs are used to ANS - Lyse a thrombus The most important food for a patient taking anticoagulants to avoid is ANS - Garlic Fibrinolysis is the result of ANS - Plasmin digesting the fibrin strands of clots How does clopidogrel prolong bleeding time? ANS - Alters the plasma membrane of platelets Following an acute myocardial infarction, your patient is receiving alteplase (Activase), a thrombolytic drug. Which of the following adverse effects could be attributed to this drug administration? ANS - Nosebleeds A patient taking Warfarin for atrial fibrillation is being checked for a therapeutic level of the drug in his system. His INR is expected to be: ANS - Between 2-3 Laboratory studies related to heparin therapy include ANS - aPtt Low molecular weight heparin ANS - Has a longer duration of action and is more stable than heparin Match the drug with its classification. 1. Heparin 2. Clopidogrel 3. Aspirin (acetyl salycilate or ASA) 4. Aleplase, activase, TPA 5. Warfarin 6. Abciximab 7. Enoxaparin ANS - 1. Anticoagulant 2. Antiplatelet 3. Antiplatelet 4. Thrombolytics 5. Anticoagulant 6. Antiplatelet 7. Anticoagulant Match the cholesterol lowering agent with patient teaching instructions for taking it. 1. Statins 2. Bile acid sequestrants 3. Niacin 4. Fibric acid agents ANS - 1. Take with your evening meal 2. Take at least 2 before meals with plenty of fluids 3. Take with cold water to decrease flushing, and consider a baby aspirin as well 4. Take with a meal Match drug with the location of action it targets. 1. Ascending limb of the Loop of Henle 2. Early distal tubule 3. Late distal tubule and collecting ducts 4. Proximal tubule and loop of henle ANS - 1. Loop diuretics 2. Thiazides 3. Potassium sparing diuretics 4. Osmotic diuretics What solute is the greatest contributor to osmolality due to its abundance in the most body fluids? ANS - Sodium When educating a patient on laxative use the nurse knows it is important to include what teaching? ANS - Chronic laxative use can result in fluid loss and hypokalemia The patient is receiving sodium bicarbonate intravenously for correction of acidosis secondary to diabetic coma. The nurse assesses cyanosis, slow respirations and irregular pulse. What is the nurse's priority action? ANS - Stop the infusion and notify the physician of the patient's alkalosis A patient is in acidosis secondary to DKA. What medication will best help to correct the acidosis? ANS - Sodium bicarbonate What is Normal Saline? ANS - Isotonic solution of 0.9% NaCl In an acute trauma situation the preferred replacement fluid is? ANS - Lactated ringers A patient being treated for DKA received an Insulin infusion, Sodium Bicarbonate, and D5W. Why did this patient receive D5W? ANS - Insulin will facilitate glucose metabolism so serum glucose may drop too quickly What is the priority electrolyte concern for a patient receiving treatment for DKA? ANS - Potassium levels dropping Insulin facilitates movement of potassium into cells You are taking care of a burn patient with 60% of his body burned from a car accident. The nurse knows that in order to keep the patient hemodynamically stable the priority nursing care is: ANS - Intensive fluid resuscitation with LR A patient is receiving dextran 40. The nurse knows a concern with rapid administration is? ANS - Fluid overload When giving a patient KCL through her nasogastric tube the nurse dilutes the medication prior to administration. Why does she do this? ANS - Decrease GI upset Albumin is considered a blood product. It is also a: ANS - Colloid Mike a 62 yr old male started taking Propranolol for dysrhythmias. What side effect of propranolol is a major risk factor for lack of compliance? ANS - Decreased libido A nurse is teaching a patient newly started on an antidysrhythmic medication. The nurse knows teaching has been effective when the patient states: ANS - I may experience more dysrhythmias because of changes in electrolyte absorption A patient is being started on Amiodarone what is the most concerning lab value? ANS - Potassium 3.1 Verapamil is what kind of antidysrhythmic? ANS - Calcium channel blocker Procainamide is what type of antidysrhythmic? ANS - Sodium channel blocker What type of antidysrhythmic is Propranolol? ANS - Beta blocker What is the classification of Amiodarone? ANS - Potassium channel blocker Atropine is used to treat what type of heart dysrhythmia? ANS - Bradycardia Adenosine is primarily used to treat what type of heart dysrhythmia? ANS - Paroxysmal supraventricular tachycardia (PSVT) A priority nursing care for a patient being started on Amiodarone is: ANS - Place patient on continuous EKG monitoring What class of drug is Diltiazem? ANS - Calcium channel blocker Nitroglycerine can be administered in all the following ways EXCEPT? ANS - Transrectally What is the most common adverse effect of Reteplase? ANS - Abnormal bleeding Thrombolytics are used in the treatment of MI's. When should they be administered? ANS - Within 30 minutes of arrival to the hospital When treating shock what is the desired outcome of any drug used? ANS - Increase tissue perfusion Epinephrine is the primary drug for which type of shock? ANS - Anaphylactic Inotropic drugs are primarily used for what type of shock? ANS - Cardiogenic Nursing practice when administering antidysrhythmics include all except? ANS - Calling the doctor prior to administration Verapamil should be used very carefully or not at all with which CV condition? ANS - Heart failure When administering any antidysrhythmic drug, it is important to monitor: ANS - Pulse A patient with Type I Diabetes asks the nurse why propranolol was stopped by his endocrinologist? The nurse replies: ANS - Propanolol may mask the symptoms of hypoglycemia What is the role of calcium in cardiac smooth muscles? ANS - To facilitate contraction What health teaching would be most appropriate for a patient started on nifedipine? ANS - Daily weights A patient with ventricular dysrhythmias is receiving lidocaine. What is the most appropriate intervention for this therapy? ANS - Monitor for paresthesias, drowsiness, or confusion Match the common adverse effects with the correct cause 1. Alopecia 2. Mucositis 3. Emetogenic 4. Extravasation 5. Infertility ANS - 1. Hair follicles are damaged 2. Epithelial lining of digestive tract becomes inflamed 3. Vomiting center in the medulla is triggered 4. Vesicants escape from an artery or vein during infusion 5. Harm caused to the gonads Match the medications listed below with the complication of chemotherapy for which it is prescribed. 1. Ondansteron 2. Filgrastim 3. Epoeitin alpha 4. Lorazepam 5. Cocktail with lidocaine, diphenhydramine, and maalox 6. Oprevelkin ANS - 1. Chemotherapy induced nausea and vomiting 2. Neutropenia 3. Anemia 4. Chemotherapy induced nausea and vomiting 5. Mucositis 6. Thrombocytopenia Match the following cancer and cancer treatment terms with the correct definition 1. Grading 2. Staging 3. Carcinogens 4. Palliation 5. Growth fraction ANS - 1. Process that examines cancer cells under a microscope 2. Process of determining where the cancer is located 3. Agents that cause cancer 4. Chemotherapy drugs administered to ease severity of pain and other tumor symptoms 5. A measure of the number of cells undergoing mitosis in a tissue Most anti-cancer agents act by ANS - Inhibiting cell proliferation Most anticancer drugs act by killing cells that are dividing, thus non cancer cells (normal cells) are not destroyed during cancer treatment. ANS - False Why are bone marrow suppression, diarrhea and alopecia so common when clients are given anticancer agents? ANS - Cells lining the GI tract, RBCs, WBCs and hair follicle cells are replaced at a very fast rate Tumors are named according to their tissue of origin, therefore most are named with the suffix ANS - - oma Chemotherapy drugs may be used for palliation. ANS - True What is the purpose of adjuvant chemotherapy? ANS - To rid the body of cancer cells after surgery or radiation What is the goal of chemoprophylaxis? ANS - To prevent cancer in patients at high risk for developing tumors Chemotherapy is preferred over surgery or radiation because a combination of drugs will kill 100% of the tumor cells. ANS - False When is the best and most effective time for oral antiemetic therapy if a patient is receiving chemotherapy? ANS - Before starting chemotherapy with high emetic potential A client who received chemotherapy 7 days ago calls and reports a temperature of 101.2 but denies chills, cough, or sore throat. What will you tell the client? ANS - You will need to be seen right away. You are at an increased risk for bacterial infection The nurse is caring for a patient with neutropenia. He wants to know what that means and why he has it. What is the best instruction by the nurse? ANS - You have a decreased number of neutrophils because the bone marrow is affected by the chemotherapy Which of the following are colony-stimulating factors used to increase the WBC count. Check all that apply. ANS - Filgrastim, Sargramostim A patient starts vomiting prior to chemotherapy. What is the probable cause? ANS - Anticipatory nausea and vomiting because the patient expects an unpleasant experience What is the priority goal of antiemetic therapy? ANS - The complete prevention of chemotherapy induced nausea and vomiting The patient is concerned about having chemotherapy induced nausea and vomiting (CINV). The nurse will instruct the patient to use which of the following medications prior to chemotherapy to prevent CINV? ANS - Ondansteron Because the epithelial lining of the GI tract is very sensitive to chemotherapy, the nurse anticipates teaching the patient ANS - Eat a popsicle during chemotherapy infusions The nurse is instructed to give a patient with mucositis "magical mouthwash". The nurse understands that this medical cocktail includes which of the following to decrease the pain. Select all that apply. ANS - Liquid diphenhydramine, viscous lidocaine, maalox A patient with mucositis from chemotherapy asks the nurse what types of food may help with the pain from the ulcerations in his mouth and esophagus. The nurse instructs the patient to eat: ANS - Creamy peanut butter, puddings, and custard Many patients with cancer experience a general wasting of muscle and other tissues referred to as: ANS - Cachexia Hair follicles are damaged by many chemotherapeutic agents. Hair loss usually begins: ANS - Within 1-2 weeks after the first treatment The medications that are given to kill the cancer may cause a secondary cancer to develop elsewhere in the body. ANS - True Which of the following statements by a patient on chemotherapy is of the most concern to the nurse? ANS - I am taking my 5 year old granddaughter to the clinic for her kindergarten immunizations A known vesicant is started on a patient with cancer. The nurse will monitor for: ANS - IV site or port for pain, redness, and swelling The nurse knows that the most common reason for delaying chemotherapy is due to which common side effect of chemotherapy? ANS - Myelosuppression A patient on chemotherapy states he no longer wants to eat. Which of the following would be the best for this client? ANS - Albumin 2.5 g/dL A patient's absolute neutrophil count is 1000/mm3. To prevent complications the most important thing a nurse will do is: ANS - Wash hands before entering the room The patient tells the nurse that his wife insists he takes herbal remedies while he is on chemotherapy. The nurse will: ANS - Determine which herbal remedies he is using and document them in the patient's chart While receiving chemotherapy sexually active male and female patients should be instructed to: ANS - Use reliable contraception during and for 3-6 months following treatment Antineoplastic medications are more likely to cause permanent sterility in women than in men. ANS - False A patient receives the following medications at 0800. Which medication does the nurse recognize as the reason for the patient feeling chilled, clammy and shaking when he checks on the patient at 1005? ANS - Humalog Regular Insulin, 5 units, SQ A patient with Type 1 DM complains of feeling sweating and shaky at 6 pm, right before dinner. His blood sugar registers 58 on the glucometer. This can be attributed to the effects of which dose of insulin? ANS - The 12 noon dose of Lantus Insulin Prior to administering Digoxin to a patient, which measurement is imperative for a nurse to assess? ANS - Heart rate A nurse administering promethazine for a patient's nausea understands the risks of IV administration include: (choose all that apply) ANS - Necrosis to the vein, swelling to veins and tissues, caustic impact to the intima of the vein, may lead to gangrene or amputation of affected limb, spasms of blood vessels Proper administration of IV promethazine includes: ANS - Dilute in the appropriate amount and utilize a slow push method, over at least 2 minutes or more The patient is receiving vancomycin to treat sepsis. The nurse would recognize a common adverse reaction would be indicated by which patient statement? ANS - What did you say? I didn't hear you When giving warfarin to a patient, which lab values are important for the nurse to review prior to administration? Check all that apply. ANS - Promothrombin time (PT), International normalized ratio (INR) A patient is receiving potassium chloride IV for a serum potassium of 3.1 mEq/L. Which severe side effect of administering the potassium too quickly must the nurse be aware of? ANS - Arrythmias leading to cardiac arrest Which over-the-counter medications are hepatotoxic and can cause liver tissue destruction when taken in large amounts? Select all that apply ANS - NSAIDs, acetaminophen An elderly patient has been taking aspirin for a headache lasting three days. The patient states she feels dizzy and has ringing in her ears. The nurse responds correctly: ANS - This may be associated with taking aspirin. I'll let the doctor know A 15-year-old with a 6-month history of moderate to severe depression started anti-depressant therapy with Sertraline two weeks ago. The nurse will teach the family that he is most at risk during the first three weeks of medication therapy for: ANS - Suicidality Prior to giving metoprolol, what parameter should the nurse assess, confirm or double-check and assure are in the patient chart? ANS - Heart rate A patient is taking an IV aminoglycoside, gentamicin, to treat a severe infection. His urine is dark, his urinary output has diminished, he is having a hard time hearing you, and he is scratching his arm. Which side effects can be attributed to taking gentamicin? ANS - Nephrotoxicity, ototoxicity A 3-year-old child comes to the clinic for an overdose of pseudoephedrine. For what signs of toxicity should the nurse be watching? Select all that apply ANS - Insomnia, tachycardia, seizures Which one of the following drugs to control pain may also cause cardiac ischemia? ANS - Sumatriptan Your client is taking aspirin, ketorolac, and a topical hydrocortisone. He reports ringing in his ears for the last day. What is the priority action you will take? ANS - Hold the next dose of aspirin and report the symptom to the healthcare provider The nurse will need to take a thorough medication history if the patient is taking warfarin and which of the following drugs? select all that apply ANS - Aspirin, acetaminophen, ibuprofen Which lab value needs to be assessed when a patient is taking acetaminophen regularly? ANS - AST and ALT Which of the following nursing assessment criteria would be appropriate to do when administering opioid agonists such as oxycodone, fentanyl and morphine? Choose all that apply. ANS - Vital signs with emphasis on respiratory rate, level of consciousness, and bowel sounds When a client is routinely taking NSAIDS, a nurse may suggest a Guaiac stool test be ordered. Why would the nurse feel this is necessary? ANS - To monitor GI bleeding When a patient requires anticoagulation therapy they are often prescribed heparin and warfarin concurrently. Why is this done? ANS - Warfarin takes several days to achieve optimum effect Which of the following patients should not receive heparin therapy due to increased risks? (Select all that apply) ANS - A patient with a GI bleed, a patient with a blood pressure of 195/100, and a patient with hemophilia A For which of the following is protamine sulfate used as an antagonist? ANS - Heparin What is an important teaching point for patients receiving warfarin therapy? ANS - Eat the same amount of food each week that are rich in vitamin K (asparagus, broccoli, cabbage, cauliflower, kale) A patient on Warfarin is having two to three nose bleeds a day and is feeling weak after five days of this condition. He comes into the ED to have his Warfarin levels checked. What would the nurse expect his lab value for an INR to be? ANS - Greater than 4 The hospitalized patient is receiving spironolactone. A consulting physician sees the patient and orders lisinopril. What is the primary assessment by the nurse? ANS - Hyperkalemia Which of the following actions by the nurse is most important when caring for a client with renal disease who has an order for furosemide? ANS - Assess urine output and renal lab values for signs of nephrotoxicity Which of the following class of lipid lowering agents puts a patient at risk for the rare but serious side effect called Rhabomyolysis? ANS - Statins In reviewing the history of a newly admitted cardiac patient, the nurse knows that the patient would have a contraindication to antilipemic therapy if which condition is present? ANS - Liver disease A patient taking a statin calls the office to report an increase in muscle pain. What should the nurse communicate next with the patient? ANS - This could be the sign of a serious side effect, stop taking the medication immediately For which of the following antilipemics are grapefruit and grapefruit juice contraindicated? ANS - Pravastatin The nurse is preparing to administer a newly ordered statin drug to a patient and is reviewing the patient's list of current medications. Which medications may cause an interaction with the statin drug? Select all that apply. ANS - Erythromycin, warfarin Why is most insulin today human insulin? Check all that apply ANS - More effective, lower incidence of resistance, fewer allergies Which of the following medications is a synthetic analog of a natural hormone released by the beta cells of the pancreas at the same time as insulin. ANS - Pramlintide (Symlin) When are type 2 antidiabetic drugs usually prescribed? ANS - After diet, exercise and one antidiabetic drug have failed to reduce blood glucose to normal levels For whom is insulin replacement therapy required? Check all that apply. ANS - Those with type 2 diabetes who are unable to manage their blood glucose levels with diet, exercise and oral antidiabetic drugs, and Patients with type 1 diabetes mellitus Almost all insulin today is from which source? ANS - Human Which of the following types of insulin is long acting? ANS - Insulin glargine What is contained in Humulin 70/30 or Novolin 70/30 premixed insulin combination? ANS - 70% NPH insulin and 30% regular insulin What is the primary adverse effect of insulin therapy? ANS - Hypoglycemia Your patient on insulin therapy has pale, cool, moist skin and is confused. What is the quickest way to reverse these symptoms? ANS - IV glucose in dextrose solution Which of the following statement is correct regarding Insulin? ANS - It is required for the cellular uptake of glucose in all cells except those in the brain Which of the following is an advantage of insulin analogs over older forms of insulin? ANS - They may have a more prolonged duration of action or a more rapid onset of action You are teaching a young woman who is taking Glipizide (Glucotrol) for Type II Diabetes. She is wondering how this medication works. What will you teach her? ANS - Stimulating the pancreas to produce more insulin Which of the following oral hypoglycemics is preferred for managing Type II Diabetes because it is safe, effective and it does not cause hypoglycemia. ANS - Metformin Incretins are: ANS - Hormones secreted by the mucosa of the small intestine following a meal Which of the following lab values is the best indicator of the average blood glucose levels over the past 3 months? ANS - Hemoglobin A1C (HbA1c) A patient recently started on linagliptin, an incretin enhancer (DPP-4 inhibitor) as monotherapy. What is the best instruction by the nurse? ANS - Immediately report any itching, rashes, or swelling of the face or tongue A class of incretin enhancers known as DPP-4 inhibitors do which of the following? ANS - Prevents the breakdown of incretins Why is Metformin contraindicated for 2 days prior to and 2 days after receiving IV radiographic contrast? ANS - It can result in lactic acidosis Metformin is used off-label to treat which of the following common problems? ANS - Polycystic ovary syndrome When taking Metformin, alcohol ________ ANS - Increases the risk for lactic acidosis What is the mechanism of action of metformin? Check all that apply. ANS - Decreases the hepatic production of glucose, reduces insulin resistance What is the most common adverse effect of sulfonylureas? ANS - Hypoglycemia When alcohol is taken with sulfonylureas such as glimepiride, glipizide, or glyburide some patients experience: ANS - A disulfiram-like reaction Which of the following classes of medications included the first oral hypoglycemic available? ANS - Sulfonylureas Which of the following medications acts by stimulating the release of insulin from pancreatic islet cells? Check all that apply. ANS - Glipizide, glimepiride, nateglinide Thiazolidinediones (TZDs) include which of the following medications? Check all that apply. ANS - Pioglitazone, rosiglitazone Thiazolidinediones (TZDs) such as rosiglitazone and piogliltazone lower blood glucose by which of the following mechanisms? ANS - Decreases insulin resistance and inhibits hepatic gluconeogenesis Riosiglitazone and pioglitazone contain a black box warning for which of the following? ANS - Heart failure and risk for myocardial ischemia What are the most common adverse effects of thiazolidinediones (TZDs)? Check all that apply. ANS - Weight gain, fluid retention, headache A client on pioglitazone calls the office complaining of swelling in her legs, shortness of breath and feeling more tired since starting the drug. What is the best instruction by the nurse? ANS - Stop taking the drug and come in for an appointment with the healthcare provider Which of the following classes of hypoglycemics are more likely to cause hypoglycemia? Check all that apply. ANS - Sulfonylureas, meglitinides Meglitinides include which of the following medications? Check all that apply. ANS - Repaglinide, nateglinide Meglitinides such as nateglinide need to be taken ANS - At or before each meal Why are meglitinides better tolerated than sulfonylureas? Check all that apply. ANS - Cause less weight gain, cause less hypoglycemia The newest class of drugs for type 2 diabetes is called sodium-glucose co-transporter 2 (SGLT-2) inhibitors. What is an SGLT-2? ANS - An enzyme in the kidney tubule that causes glucose to be reasorbed from the urine SGLT-2 inhibitors (Gliflozins) include which of the following medications? Select all that apply. ANS - Canagliflozin, Empagliflozin, Dapagliflozin How do SGLT-2 inhibitors work? ANS - Prevents the kidneys from reabsorbing glucose back into the blood For which patients are SGLT2 inhibitors prescribed? ANS - People with type 2 diabetes that have hyperglycemia despite use of other hypoglycemic medications When a patient is started on cangliflozin what is critical to teach the client? Check all that apply. ANS - Risks of signs and symptoms of hypoglycemia, to call your health care provider if you have s/s of a urinary tract infection Which of the following mechanisms is used to describe when a person drops his blood glucose in the middle of the night, but wakes up in the morning with a high glood glucose level? ANS - Somogyi phenomenon Match the drug to the mechanism of action. 1. Glipizide 2. Acarbose 3. Pioglitazone 4. Repaglinide 5. Sitagliptin 6. Metformin 7. Insulin 8. Canagliflozin ANS - 1. Stimulates the release of insulin from the pancreas 2. Delays digestion of glucose in the small intestine 3. Decreases insulin resistance primarily 4. Stimulates the release of insulin from the pancreas 5. Prevents the breakdown of incretins 6. Decreases hepatic production of glucose primarily 7. Promotes cellular uptake of glucose 8. Blocks the kidneys reabsorption of glucose Match: 1. Glucagon 2. Insulin ANS - 1. Increases blood glucose 2. Decreases blood glucose A nurse administering IV calcium should consider: Choose all that apply. ANS - - Monitor IV site closely for signs of infiltration - Monitor serum calcium levels to avoid hypercalcemia - Administer slowly to avoid hypotension, dysrhythmias and cardiac arrest Symptoms of hypocalcemia are: Choose all that apply. ANS - muscle twitching and tremors cardiac dysrhythmias numbness and tingling of the extremities abdominal cramping Which patient group can we expect will have problems maintaining their levels of vitamin D? ANS - Patients on dialysis - Yes, parathyroid hormones from the kidneys should tell the kidney to change inactive vitamin D to active vitamin D, but this would be affected if they were on dialysis. Taking calcitriol is not completely risk free. Which of the following can occur when taking calcitriol with a particular drug? Select all that apply. ANS - Thiazide diuretics: hypercalcemia -Yes, unfortunately. For instance, hydrochlorothiazide can cause hypercalcemia when taken with calcitriol. Digoxin: dysrhythmias Magnesium: hypermagnesemia T/F Taking Calcitriol (vitamin D) can cause hypercalcemia. ANS - True What vitamin is also known as Vitamin D? ANS - Calcitrol What assessment findings in a patient taking calcitriol should the nurse recognize and report to the provider immediately? ANS - Muscle twitching, numbness, and tingling of the extremities Raloxifene is a selective estrogen receptor modulator (SERM.) It is primarily used for the prevention of osteoporosis in postmenopausal women. Other uses include which of the following: ANS - Prevention of vertebral fractures caused by osteoporosis of the spine Drug -Drug interactions for the use of Raloxifene include: (mark all that apply) ANS - Black cohosh or other estrogen-related drugs Ibuprofen Ampicillin Warfarin A patient receiving Alendronate (Fosamax) to treat osteoporosis becomes discouraged due to perceiving "not feeling stronger bones yet" and states that he is going to stop taking the medication. Teaching for this patient should include: (mark all that apply) ANS - Instructions for proper administration (e.g., taken with water) Information regarding peak time for drug effectiveness, as this medication might take 1-3 months to reach full effect Administration alerts for the antirheumatic drug hydroxychloroquine include: (Choose all that apply) ANS - Store out of the reach of children Take at the same time every day Possible ocular effects of taking hydroxychloroquine include blurred vision, photophobia, diminished ability to read, and blacked-out areas of the visual fields. However, even with high doses or prolonged therapy with visual field changes, these retinal symptoms can be reversed. ANS - False Hydroxychloroquine overdose in children may be life threatening. Treatment for overdose may include: (mark all that apply) ANS - Vasopressors Anticonvulsants Antidysrhythmics Why would a patient be taking hydroxychloroquine? ANS - Rheumatoid arthritis - Yes, hydroxychloroquine is an antirheumatic drug used to slow the disease and enhance the quality of life for those with RA. T/F Hydroxychloroquine would be prescribed for a patient with rheumatoid arthritis early in the disease process ANS - True For what disorder is allopurinol prescribed? ANS - Gout A patient receiving allopurinol for gout symptoms asks why he should decrease his alcohol intake. The nurse's response is based on the knowledge that alcohol: ANS - Raises Uric Acid Levels Allopurinol is given for what purpose when treating gout? ANS - Blocks xanthine oxidase which keeps the body from forming uric acid crystals. Colchicine is prescribed for its: ANS - Anti-Inflammatory properties Patients taking colchicine should have their blood levels tested for which of the following abnormal values? ANS - MCV (Size of RBC's) Patients who begin taking colchicine should be taught to avoid eating grapefruit and drinking grapefruit juice as it may: ANS - Decrease hepatic metabolism of colchicine Alendronate is prescribed for ANS - Decreasing bone resorption What kinds of patients may benefit from taking alendronate? Choose all that apply: ANS - Individuals taking steroids, like prednisone, for long periods of time Aging individuals Post-menopausal women Instructions for taking alendronate include: (check all that apply) ANS - "Take this at the same time of the morning" "This should not be taken with antacids, iron or other vitamin supplements" "Stay upright and do not lay down for 30 minutes to an hour after taking this medicine." Calcitonin is a hormone secreted by the _____________ when serum calcium is elevated. ANS - Thyroid Gland T/F Calcitonin is considered a first-line treatment for osteoporosis. ANS - False Calcitonin, used to help put calcium back in the bones ("calcitonin tones the bones"!), is primarily administered through the intranasal inhalation route. What side patient teaching should be done for the patient for this drug? ANS - "Your nose may become irritated." What is true of calcitonin? (Choose all that apply) ANS - Acts in opposition to vitamin D Can be used to treat hypercalcemia in the blood Increases bone density Acts in opposition to parathyroid hormones (PTH) Identify risks for osteoporosis: Select all that apply. ANS - Advancing age Family history of osteoporosis High alcohol consumption Testosterone decline Why might a child be prescribed topical permethrin? ANS - To eliminate hatched lice Teaching for a parent prior to them assisting a child with topical permethrin application should include: (Choose all that apply.) ANS - "Keep this out of your child's eyes, as it will cause irritation." "You may need to treat your child within nine days after the eggs hatch." "You can purchase this drug over-the-counter." T/F Teaching for parents of children with lice may include normalizing a lice infestation, as it is common for school-aged children to have. ANS - True Teaching for patients taking tretinoin includes: (Choose all that apply) ANS - "Don't use other over-the-counter acne medications or skin products that will dry your skin." "Avoid direct sunlight and use sunscreen, as you are more likely to have skin damage when using this." Yes, the skin gets sensitive when using tretinoin. Uses for tretinoin, a natural derivative of vitamin A include: Select all that apply. ANS - Wrinkle reducer Acne treatment @ Yes! It is indicated for the early treatment and control of mild to moderate acne vulgaris Which patient would be cautioned before taking tretinoin by mouth? ANS - Female of childbearing years For what condition is a patient prescribed latanoprost? ANS - Glaucoma After two weeks of using latanoprost for open-angle glaucoma, the patient complains that he has irritation, stinging and redness in his eyes. Education the nurse would provide to the patient would include: ANS - "This is a normal response during the first month of therapy. Use the drops at bedtime so you are not feeling that irritation as much." A patient with open angle glaucoma who has been taking latanoprost drops in her eyes complains of severe pain in one eye, severe headache, and blurred vision in both eyes. What should the nurse do in response to this? ANS - Notify the healthcare provider immediately. For what condition of the eye are timolol eye drops frequently prescribed? ANS - Open-angle glaucoma - Timolol reduces pressure in the eye by reducing aqueous humor in the eye. For which patient's conditions is timolol eye drops, a beta blocker, contraindicated? Check all that apply. ANS - COPD Asthma Heart Block Slow heart rate A patient has open-angle glaucoma. Choose the medication that would be administered to him for this condition. ANS - Timolol - Timolol decreases the production of aqueous humor, which lessens the pressure in the eye (IOP) What instructions would the nurse give a patient with a new prescription for timolol eye drops? Check all that apply ANS - "Wash your hands before giving yourself these drops." "Occlude the inner canthus of the eye for a minute after the drop is given." "Avoid touching the tip of the bottle to the eyelid or eye." What are the most common types of calcium supplements that can be purchased over-the-counter (OTC)? Choose all that apply. ANS - Calcium Carbonate Calcium Citrate Calcitriol (Vit. D) can be obtained through which of the following routes? ANS - By spending time with skin exposed to the sun Tablet Capsule What physiologic change associated with normal aging may affect geriatric patient's clinical response to medications? ANS - Prolonged half-life of lipid-soluble drugs, due to a higher relative composition of body fat What physiologic change associated with normal aging may affect an older adult's response to drugs? ANS - Decreased responsiveness of the carotid baroreceptors - Aging is associated with decreased cardiovagal baroreflex sensitivity, thus more variation in BP with an impaired ability to respond to acute challenges in maintaining blood pressure. Anticholinergic medications, which include antihistamines, cause which of the following? ANS - Dry mouth (Xerostomia) and delirium A patient on your watch became very agitated and confused after medications you administered. Which of the following is the best explanation for his overall clinical presentation? ANS - Anticholinergic effects of the promethazine precipitated delirium, and lorazepam had a paradoxical effect Providing safe and effective drug therapy for the elderly. Why is it so difficult? ANS - Aging can alter pharmacodynamics and pharmacokinetics. Prevalence of prescription drug use among older adults increases substantially with age. What percentage of people 65 and older use at least 1 drug per week? ANS - 90% Because diazepam and flurazepam have half-lives up to 96 hours in elderly patients. When may signs of toxicity appear? ANS - Days or weeks after therapy is started. Serum levels of unbound (free) drug may increase in which of the following patients? ANS - A 72 year old who has stopped eating due to grief related to loss of a loved one. Because hepatic metabolism of many drugs decreases with age, drugs metabolized in the liver during phase 1 will be cleared: ANS - Slower Phenobarbital, propranolol and nitrates are metabolized before the drug reaches the systemic circulation and is also affected by aging. This phenomenon is called: ANS - First-pass metabolism First-pass metabolism is affected by aging and decreased by about 1% per year after the age of 40. Thus, for a given oral dose of nitrates, the elderly may have: ANS - Higher circulating drug levels Which of the following has a high risk of toxic effects due to age-related decreases in first-pass (usually hepatic) metabolism? ANS - Prapranolol With age, small bowel surface area decreases, gastric emptying slows, and gastric pH increases. Changes in drug absorption in the elderly tend to be clinically inconsequential for most drugs. Which of the following is less effectively absorbed in this environment? ANS - Calcium carbonate - calcium carbonate requires an acidic environment for optimal absorption What is the anticipated effect of drug distribution on volume in elderly patients who have increased body fat? ANS - Increased volume of distribution for highly lipophilic drugs One of the most important pharmacokinetic changes associated with aging is related to renal elimination of drugs. After age 30, what happens in the kidneys? ANS - Creatinine clearance decreases Why do serum creatinine levels often remain within normal limits as we age despite a decrease in GFR? ANS - Elderly generally have less muscle mass and are generally less physically active than younger adults. Which of the following drugs may be toxic in elderly patients because serum albumin levels decrease with age? ANS - Warfarin Which of the following is used to guide dosing of drugs with potentially decreased renal elimination in elderly patients? ANS - Creatinine clearance Elderly patients are particularly sensitive to anticholinergic drug effects. When a patient takes a drug such as diphenhydramine which has anticholinergic effects what are your concerns? ANS - Increased confusion Clinicians will frequently underprescribe medications because of increased concern about adverse effects. ANS - True What source is the most accurate for specific recommendations for childhood immunizations? ANS - CDC How many doses of the DTaP immunization are recommended for young children? ANS - 5 At what age is it recommended that an adolescent receive a booster of the DTaP vaccine? ANS - 11-12 years As an adult, how often should a tetanus immunization? ANS - Every 10 years What immunizations are recommended to be given at 4-6 years prior to entering school? ANS - DTaP, IPV, MMR, Varicella How many doses of the MMR vaccination are recommended for children? ANS - 2 What immunization it typically given at birth? ANS - Hepatitis B Which of the following immunizations is for Haemophilus influenza type B? ANS - Hib Why is it recommended that all children receive the HPV vaccination? ANS - the human papilloma virus is associated with the development of cervical cancer in women and males can be carriers of the virus How many doses of the varicella vaccination are recommended? ANS - 2 At what age is it recommended that the annual influenza immunization be started for a healthy child? ANS - 6 Months At what age is the meningococcal vaccine often given? ANS - 18 years At what age is it recommended that adults receive the pneumococcal vaccine? ANS - 65 years The current recommendation for adults over the age of 65 to receive the follow up 23-valent pneumococcal vaccine (PPSV23) is: ANS - at least one year after the PCV13 vaccine at what age should an adult get the herpes zoster vaccination (HZV)? ANS - 60 years, regardless of whether they had a prior episode of herpes zoster Because children may develop a low-grade fever after any immunization, counsel parents they may need to give acetaminophen or ibuprofen for a fever higher than 38.4 C (101 F). ANS - True Most drugs used to treat Alzheimer's disease affect: ANS - cholinergic pathways, enzymes, and receptors A nurse will prepare teaching materials regarding which drug for the parents of a child diagnosed with attention-deficit/hyperactivity disorder (ADHD)? ANS - Methylphenidate Dextroamphetamine is prescribed to an 8-year-old child for the treatment of attention-deficit/hyperactivity disorder (ADHD). The nurse plans to monitor which of the following during the medication therapy? ANS - Height and Weight The child most likely to receive risperidone to manage symptoms is one diagnosed with: ANS - autistic spectrum disorder (ASD). The family of a patient diagnosed with Alzheimer's disease asks the nurse, "How can drugs help our parent?" The reply that provides the most realistic expectations would be: ANS - "Drugs can help preserve mental abilities for a time." Select the most realistic short-term goal for the care of a patient with mild Alzheimer's disease who takes donepezil. The patient will: ANS - maintain present cognitive ability. Which statement by a family member of a patient diagnosed with Alzheimer's disease demonstrates that medication education was effective? "The medication my parent is receiving: ANS - inhibits breakdown of an important neurotransmitter and may slow disease progression. An adult says, "I take provastatin for my high cholesterol. It will prevent stroke and heart attack." Select the nurse's most informative response. ANS - "Some research indicates that statin drugs may also interfere with development of Alzheimer's disease." A patient began trihexyphenidyl for treatment of Parkinson's disease. Which finding demonstrates a positive response to the medication? ANS - Gait is steady with decreased rigidity. An elderly nursing home resident has been diagnosed with type 2 diabetes, hypertension, and dementia. The patient begins taking an antipsychotic drug for agitation. Tremor and bradykinesia develop, so an anticholinergic is added to the drug regimen. Within 3 days the patient displays a marked cognitive deficit. Which medication is the most likely cause of the cognitive change? ANS - Acetylcholine A nurse is preparing to give an IM injection to a patient that is 6 months old. What injection site would be best? ANS - Vastus Lateralis A newborn is given IV antibiotics. What assessment parameter addresses the newborns ability to distribute the antibiotic throughout the body? ANS - Plasma Protein Levels - Many drugs are transported by plasma proteins. Newborns with immature liver function may not have enough serum albumin to transport drugs readily. Trimethoprim and sulfamethoxazole should not be given to infants under two months old. This is because of what possible complication? ANS - acute bilirubin encephalopathy Some medications when prescribed for children must be given more frequently than for adults. What explanation is correct? ANS - children have a faster basic metabolic rate than adults Tretinoin is a topical agent commonly used to treat acne. Nursing considerations with this drug include: ANS - explaining that medication should not be applied until at least 20-30 minutes after washing When is isotretinoin indicated for the treatment of acne during adolescence? ANS - the acne has not responded to other treatments A nurse is teaching parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate. Which should the nurse include in teaching about the side effects of this medication? ANS - "your child may experience a sense of nervousness." A child has been diagnosed with enuresis. TCA imipramine has been prescribed for the child. The nurse understands that this medication is in which category? ANS - antispasmodic What is beneficial in reducing the risk of Reye syndrome? ANS - Avoidance of aspirin to treat fever associated with influenza When takin the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from: ANS - varicella A child's mother tells you, "The doctor has prescribed our daughter digoxin to take at home. Are there any special things we should do?" What patient teaching is needed? ANS - prior to administration take an apical pulse. Do not give the medication if the pulse is below 100 beats/min. - Always assess apical pulse before giving Digoxin Which fluid class do we give most often in the hospital for those with dehydration of any cause? ANS - Crystalloids Choose the definition of a colloid: ANS - IV fluids that contain proteins or other large molecules Choose the definition of a crystalloid: ANS - IV fluids that contain electrolytes in concentrations resembling those of extracellular fluid (fluid). Choose the definition of an isotonic solution: ANS - Of the same concentration as the blood Hypovolemic shock can be triggered by which of the following conditions: (choose all that apply) ANS - Excessive or prolonged diarrhea Bleeding from trauma Excessive sweating Hypovolemic shock can be triggered by which of the following conditions: (choose all that apply) ANS - Intensive diuretic therapy NG suctioning Diarrhea Vomiting What does "D5W" mean ANS - 5% Dextrose in sterile water (5 grams per 1000 mL) With which lab value would the nurse expect to give IV potassium chloride to treat a patient's potassium level? ANS - For a blood potassium level of 2.8 If a patient were receiving IV potassium chloride for potassium replacement, what symptoms would the nurse be concerned about if the patient reported it? (Choose all that apply) ANS - "I'm feeling nauseous." What principle of physics do colloids use to move water across the vascular membrane? ANS - Oncotic pressure A patient who loses 15 % of his blood supply due to hemorrhage will most likely receive packed red blood cells to help improve oxygen carrying capacity of his system. ANS - False Which statement is NOT true concerning the reason crystalloids are given to patients? ANS - Pull fluid into the vascular space to help pressure in the blood vessels (veins) increase A nurse will expect which symptom or occurrence when giving Dextran 40? ANS - Blood pressure rising from 110/62 to 145/81 Why does Dextran 40 stay in the veins after being given? ANS - Its molecules are too big In what routes and formularies can potassium chloride replacements be given to a patient with potassium of 3.1? Choose all that apply. ANS - Oral powder to be mixed in liquid Tablet IV Drip IV potassium chloride replacement needs to be given slowly since it has a tendency to be caustic to the veins. ANS - True Powdered potassium chloride supplements need to be given: ANS - Diluted in water or juice The nurse will be aware that giving potassium chloride to which patients are contraindicated: (Choose all that apply) ANS - A patient with chronic renal failure - Patients with CRF do not excrete potassium through the kidneys since they are so damaged. So, question of an order to give potassium replacements to CRF patients, because it is contraindicated to give. The patient taking a potassium sparing diuretic such as spironolactone - A potassium sparing diuretic means there is more potassium left in the body. So if potassium replacements are given, it can cause a build up of potassium with hyperkalemia resulting. Not good! A patient has been receiving NS to correct dehydration due to diarrhea she's had for the past two days. When the patient complains of tightness in the chest and slight swelling in the fingers, what can the nurse do next and why? ANS - Listen to the lungs. Edema may be developing in the lungs due to the fluid administration To whom should normal saline be contraindicated? (Choose all that apply) ANS - To CHF Patients To Hypernatremic Patients To Dialysis Patients A patient has metabolic acidosis. Which IV fluid would the RN expect to begin? ANS - Sodium bicarbonate Some indications for giving sodium bicarbonate IV are: (Choose all that apply) ANS - After an overdose of medicines- for example aspirin, TCAs or phenobarbital For a pH 7.1 A patient with a sodium level of 151 mEq/L. What would be the expected actions from the nurse? (Choose all that apply) ANS - Notify the doctor of this value Expect an order for the patient's diet change to a low-sodium diet Which of the following interventions is the most important intervention when administering a plasma volume expander to a patient? ANS - Observe for signs of fluid overload A patient complains of cramps in his calves, parasthesia to his toes and a feeling that his heart is not beating normally. These symptoms may indicate which of the following imbalance? ANS - Hyperkalemia What is Lactated Ringer composed of? (Choose all that apply) ANS - Sodium lactate Potassium Sterile water Calcium Sodium chloride Match the category with its fluid replacement agent: 1 - Blood product 2 - Colloid 3 - Crystalloid ANS - 1 - Fresh frozen plasma 2 - Dextran 40 3 - Normal Saline Match the category with its fluid replacement agent: 1 - Blood product 2 - Colloid 3 - Crystalloid ANS - 1 - Packed RBC's 2 - Albumin 3 - Lactated Ringers Match the category with its fluid replacement agent: 1 - Blood product 2 - Colloid 3 - Crystalloid ANS - 1 - Whole Blood 2 - Plasma protein fraction 3 - D5W The blood bank is going to separate out component parts of blood. Choose which part of the blood matches which description: 1 - Red blood cells 2 - White blood cells 3 - Platelets 4 - Albumin 5 - Fresh frozen plasma 6 - Globulins ANS - 1 - Erythrocytes 2 - Leukocytes 3 - Thrombocytes 4 - Large (protein) molecules found in blood, often given to cirrhosis patients who are at risk from compromised protein production 5 - Contain clotting factors (e.g. Factor VIII, but isn't considered a "blood product") 6 - Proteins in the blood, which when given can help the immune system fight - there are actually 4 kinds of these Choose the action and purpose of the elements given: 1- Dextran 40 2- Potassium chloride 3- Sodium chloride 4- Sodium bicarbonate ANS - 1- Given as a colloid to pull fluid back into the vascular space and thereby help BP increase 2- Given as an electrolyte replacement 3- Given as a crystalloid to patients to promote urinary output and reduce the effects of dehydration 4- Given to help correct acid-base imbalances Match the following: 1- Isotonic normal saline 2- Hypertonic saline 3- Hypotonic saline 4- Isotonic ANS - 1- 0.9% NS 2- 3% NS 3- 0.45% NS 4- Lactated Ringers Match the interaction of sodium bicarbonate with the following medications: 1- Ketonoctozole 2- Pseudoephedrine and ephedrine 3- Lithium 4- Aspirin and other salicylates 5 -Milk or calcium supplements ANS - 1- May decrease the effectiveness of this antifungal 2- May decrease elimination causing more CNS symptoms of drowsiness 3- May cause this drug to be excreted faster 4- May cause this class to be excreted faster 5- Likely to cause hypercalcemia and kidney failure Phenylephrine can be administered intranasal, ophthalmic, intramuscular (IM), subcutaneous, and intravenous (IV). With these options, IV is the preferred route for this medication. ANS - False Prazosin can be used for the following condition: ANS - Hypertension Bethanechol is used to decrease smooth-muscle tone and muscular contractions in the GI tract following general anesthesia. ANS - False Low doses of Atropine decreases sweating, salivation, and respiratory secretions. ANS - True Administration alerts for Physostigmine include (select all that apply) ANS - Continuous infusions should never be used Monitor blood pressure, pulse, and respirations Administer slowly over 5 minutes Diphenhydramine can be used for the following conditions (select all that apply) ANS - Anaphylaxis Anxiety and insomnia Allergic rhinitis Parkinson's disease The classification for Phenobarbital includes:Select all that apply. ANS - Sedative/hypnotic Anticonvulsants Diazepam rapidly absorbs from both the GI tract and IM sites ANS - False Nursing care for patients receiving Phenytoin through an enteral tube feeding or NG tube should include (select all that apply): ANS - A two hour delay between feeding and phenytoin administration