VATI Pharmacology 2023 with complete solution

A client with a digoxin level of 2.4 ng/ml has a heart rate of 39. The health care provider prescribes atropine sulfate. What best describes the intended action of atropine for this client? To accelerate the HR by interfering with vagal impulses *Atropine-anticholinergics What is felbamate used for? refractory partial and generalized seizures, Lennox-Gastaut syndrome What is Lennox-Gastaut syndrome? kids 7 y/o with mental retardation and seizures (any type) What are the S/S of Herpes simplex 2? Vesicular lesions Tingling pains Fever HA Swollen lymph nodes What are astringents? Liquid-based formulas that contain alcohol that help cleanse skin, tighten pores and dry out oil. Astringent pads used to relieve itching, burning, and irritation caused by hemorrhoids What is an adverse effect of glucocorticoids? Peptic ulcers b/c glucocorticoids irritate the gastric mucosa How do glucocorticoids affect potassium? Cause hypokalemia Zolpidem (Ambien) causes what adverse effect? Dizziness and daytime drowsiness *used for insomnia What is hydroxychloroquine? Antimalarial med used for RA. High risk of SE of retinopathy, which can be irreversible and cause blindness How should hemorrhoids be treated? -Increase fluids and fiber to soften stool and reduce straining -Topical analgesic ointments -Astringent pads When is herpes simplex most transmissible? Equally transmissible in active and latent stages What is doxepin (Silenor)? Tricyclic antidepressant (TCA) used for depression, anxiety, and insomnia. Anticholinergic effects and postural hypotension What is clonidine? An alpha 2 agonist used for HTN, severe pain, and ADHD. Common adverse effect: dry mouth When removing a central line from a client's right internal jugular vein, how should the client be positioned? Trendelenberg. Entry site should be below the level of the client's heart (limit blood's ability to flow for a bit) What are the SE of Bumex (bumetanide)? -hypokalemia -postural hypotension -Ototoxicity -Nephrotoxicity -HA -loss of appetite How does an increase in sodium levels affect lithium levels? Decreases lithium levels *Indirectly related How does a decrease in sodium levels affect lithium levels? Increases lithium levels *Indirectly related How do loop diuretics work? Prevent sodium from leaving the filtrate (pre-urine), so water stays in filtrate too, leading to Na and water excretion. Also hypokalemia-Causes loss of K+ into urine. Risk of Ototoxicity, hyponatremia, hypokalemia, What should you do if you note an elevated serum amylase in a patient? Call doctor immediately because this indicates a pancreatic disorder which is dangerous What does elevated serum amylase indicate? Excess pancreas enzyme: amylase. Acute pancreatitis or other pancreas disorder What is Ethcrynic acid (Edecrin)? Loop diuretic- What is Bumex (bumetanide)? Loop diuretic-blocks reabsorption of sodium and water in the tubules of the kidneys. It is usually prescribed for HF to reduce excessive fluid. It is more potent than lasix Common SE: -hypokalemia -postural hypotension -Ototoxicity -Nephrotoxicity -HA -loss of appetite The designation of proximal, medial, and distal ports on a central venous catheter is related to: The location of the eyelets at the end fo the catheter in the vein (the different endpoints of the central line along the SVC) A provider prescribes gold salts for a client with rheumatoid arthritis. For what serious side effects will the client require monitoring? Diarrhea Leukopenia Thrombocytopenia What is stomatitis? painful inflammation and sores of the oral mucosa (can be seen in chemo pt's) How does diphenhydramine (Benadryl) work? Competes with histamine for receptors; thus reducing vasodilation of capillaries, pruritis, and inflammation (d/t lack of histamine binding) How much fluid does a syringe pump push? 60 mL (its the pump that sits on a surface and pushes a syringe's fluid over a preset period of time) What route must lipids be administered in? Peripheral IV or central line Lipid emulsions need what to be administered? An infusion pump to avoid a rapid influx of emulsion into intravascular system How should lipid emulsions be hung in relation to the filter? Below filter tubing (so they don't clog filter) When must TPN tubing be changed by? 72 hours (but most often every 24 hours) TPN must be administered with what? Filter tubing to reduce the risk of particle chunks from entering the bloodstream (two parts: lipid emulsion and amino acid/dextrose solution) What is gentamicin and what is an important adverse effect to be aware of? An aminoglycoside antibiotic that can be toxic to the 8th cranial nerve and kidneys What do chills, rigor, fever, dyspnea, light-headness, and flank pain indicate? Blood transfusion reaction What are the most common complications of blood transfusions? Febrile nonhemolytic and chill-rigor reactions What is the most life-threatening complication associated with blood transfusions? Transfusion-related circulatory overload. S/S of HF and dyspnea. What is xerostomia? dry mouth from decreased saliva production What does increased thirst indicate when taking lithium? Lithium toxicity Does cream cheese contain tyramine? No, so you can eat it when on an MAOI What is Phenelzine (Nardil)? Monoamine Oxidase Inhibitor (MAOI) used to treat recalcitrant depression as well as Parkinson's and several other disorders A client with what electrolyte imbalance will display tetany? Hypocalcemia For what type of client should an antepartum nurse initiate seizure precautions? A client with severe gestational HTN b/c it can trigger seizure activity Why shouldn't children with asthma receive aspirin? Sensitive to it and it is associated with Reye syndrome What is the sublimation defense mechanism? Funneling of an unacceptable impulse into a socially acceptable activity. ex: person who loves cutting and blood, becomes a surgeon instead of a murderer. Amitriptyline (Elavil) causes what adverse effects? tricyclic antidepressant that causes anticholinergic side effects What is chlorpromazine (Thorazine)? First gen antipsychotic used for positive symptoms of schizophrenia. What is Nalbuphine? An opioid analgesic What is Butorphanol? An opioid analgesic What is pentobarbital (Nembutal)? - used for general anesthesia but in decline - can be used to induce coma Atresia absence of a normal body opening; occlusion; closure What does dark urine indicate? Biliary atresia-Impaired excretion of bilirubin into the GI tract that instead is excreted in urine-dark urine What is the point of maximal impulse for heartbeats? Fifth intercostal space at the midclavicular line left of the sternum Vomiting is a manifestation of what type of withdrawal? Opioid withdrawal How do aspirin and other NSAIDs interact with captopril? They reduce its antihypertensive effects abdominal cramping, weakness, confusion, lethargy, headache, and nausea indicate what type of electrolyte imbalance? Low sodium Abdominal cramping is a a manifestation of what type of electrolyte imbalance? Low sodium levels A positive Chvostek's sign is a manifestation of what type of electrolyte imbalance? Hypomagnesemia and hypocalcemia Numbness of the extremities is a manifestation of what type of electrolyte imbalance? Hyperkalemia What is shigella and what precautions? Vector: water and soil born Bacillary/bacterial dysentery (blood in stools) Contact precautions A nurse is planning to insert a peripheral IV catheter for an older adult. What action should the nurse take? Place the client's arm in a dependent position because the veins will dilate d/t gravity What is levofloxacin used for? It is considered the "work horse" of the Fluorquinolones- broad spectrum anti-infective for the following infections: UTI's, CAP, sinusitis, travelers diarrhea and STI's A nurse is caring for a client who has HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nurse should monitor the client for what adverse effects of this med? -Aplastic anemia (severe myelosuppression resulting in anemia, agranulocytsos, and thrombocytopenia) -Lactic acidosis What is aplastic anemia? Severe myelosuppression that results in anemia, agranulocytosis (decreased WBCs), and thrombocytopenia A nurse is teaching a client who has a new prescription for sumatriptan tablets to treat migraine headaches. What instructions should the nurse include? Report swelling of eyelids and lips after dosage to provider b/c it indicates an allergic reaction to the med When can a client repeat the dose of sumatriptan for an unrelieved headache? 2 hrs What is Sumatriptan (Imitrex) used for? Sumatriptan is a migraine abortive treatment that acts by causing vasoconstriction at the neural area, counteracting the vasodilation that is thought to cause migraines. It is best taken when the aura of a migraine presents. As a triptan, it is associated with fetal deaths, and therefore contraindicated in pregnancy. What PT values should a nurse expect when a client is on warfarin? 1.5-2.5x the baseline of 11-12.5 seconds (so, 17-32 seconds) A nurse is providing discharge teaching for the parents of a preschool-age child who has a new prescription for amoxicillin/clavulanate suspension. Which of the following instructions should the nurse include in the teaching? (Select all that apply). A. You will give the med every 4 hours B. Shake the med bottle well before each dose is given C. Store the med in the fridge D. Report diarrhea to the provider immediately E. Discard the unused portion of the med after 21 days B, C, D B. Shake the med bottle well before each dose is given (suspension that should be mixed) C. Store the med in the fridge D. Report diarrhea to the provider immediately (could be manifestation of Cdiff and should be reported because antibiotics kill the bacteria that suppress Cdiff) *Discard unused med after 14 days *administer every 8-12 hr as prescribed What do decreased urinary output and bladder spasms indicate during continuous bladder irrigation? Internal obstructions of the catheter. So, irrigate with 0.9% sodium chloride A nurse in the ED is caring for a client who is unconscious and requires emergency medical procedures. The nurse is unable to locate members of the client's family to obtain consent. What action should the nurse take? Proceed with provision of medical care. Life-saving care can proceed because the law considers it implied consent At what lead level should a nurse schedule chelation therapy? 45 mcg/dL A client has a clogged percutaneous gastrostomy feeding tube. What action should the nurse take first? Change position of the client. Least restrictive and may remove any kinks in the tube, which can lead to clogging. (next nurse should attempt to flush or aspirate tube contents) What is the therapeutic aPTT level for a patient on heparin? 60-80 seconds (40 seconds multiplied by factor of 1.5 to 2) What is the expected aPTT value? 40 seconds Calcium-containing antacids can cause what adverse effect Flatulence Cimetidine (Tagamet) can cause what adverse effect? It is an H2 receptor antagonist that can cause dysrthythmias What is the treatment for Cushing's Triad? Mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema What is tamoxifen used for? breast cancer What clients are contraindicated for oral contraceptives? -35 (e.g. 40 y/o or 70 y/o) -Smoker *Increases risk of thromboembolism What should the nurse do to injection site after heparin administration? Apply firm pressure to site for 1-2 minutes. DO NOT MASSAGE-can cause bleeding What type of needle should be used to administer heparin? 25- or 26-gauge 3/8 in or smaller Where should heparin be injected? Abdomen above level of iliac crest, at least 2 inches from umbilicus What is rifampin used for? used to treat TB How long does rifampin treatment last for? 6-9 months When should rifampin be taken in relation to meals? Empty stomach 1 hr before or 2 hrs after meals What is carbamazepine? Anticonvulsant used for seizures, trigeminal neuralgia, bipolar disorder, and diabetic neuropathy What is Piperacillin/tazobactam? Broad spectrum anti-infective used in treatment of moderate-severe infections What are mydriatic medications? Drugs that dilate the pupil. Can help reduce inflammation and discomfort in eye after surgery or injury What is phenylephrine? Mydriatic medication to dilate pupils to facilitate intraocular surgery What is a miotic medication? Drug causing miosis (constriction of pupil). It reduces eye pressure by increasing drainage of intraocular fluid through trabecular meshwork. Used for glaucoma What is Pilocarpine? muscarinic agonist, miotic drug used for the treatment of glaucoma What is Latanoprost? Prostaglandin used for treatment of glaucoma What does a daily calcium supplement and flank pain indicate? Renal stones What is the antidote for acetaminophen toxicity? Acetylcysteine (Mucomyst) What is the antidote for benzodiazepines? Flumazenil (Romazicon) What is the antidote for severe digoxin toxicity? Fab antibody fragments (AKA digoxin immune Fab). It binds to digoxin and blocks its action. Given IV What are some manifestations of mild lithium toxicity? -Polyuria -Diarrhea -lassitude=state of physical or mental weariness; lack of energy -Muscle weakness What is lassitude? a state of physical or mental weariness; lack of energy What should fluid intake look like with allopurinol? Drink 2L of fluids/day b/c adverse effect of allupurinol is renal damage How does aspirin affect gout? Avoid it, it can induce a gout attack Can allupurinol be crushed? Yes, it is not enteric-coated or sustained-release What are the side effects of salicylism (aspirin toxicity)? Sweating, HA, dizziness How should a client be positioned for nasal instillation? Supine A nurse is administering nasal decongestant drops to a client. What action should the nurse take? Tell the client to blow her nose gently before the instillation. This will help remove any secretions or crusts that could interfere with the distribution and absorption of the med How long should a client remain in the same position when administering nasal decongestant drops? 5 minutes to make sure drops do not run out when he sits up or stands up Hydrochlorthiazide (HCTZ) potassium wasting or sparing? Potassium wasting, you'll experience hypokalemia What does muscle pain indicate if a client is on hydrochlorothiazide? May be an indication of hypokalemia Is a nurse allowed to transcribe a provider's order into the client's health record? Yes What should a nurse do if a provider leaves a recorded order message (even if she can hear and understand it clearly)? Call the provider and obtain the prescription verbally over the telephone A nurse is planning care for a client who is to receive a competitive neuromuscular blocking agent. What should the nurse have at the client's bedside? Bag-valve-mask device. Competitive neuromuscular blocking agents prevent acetylcholine from activating receptors on the skeletal muscles and cause muscle relaxation. These agents can cause respiratory arrest due to relaxation of the respiratory muscles. The nurse should have a bag-valve-mask device, endobrachial intubation equipment, and oxygen at the bedside of a client who is receiving this medication to reduce the risk for respiratory arrest. A nurse is preparing to administer phenytoin IV to a client with a seizure disorder. What action should the nurse take? Flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation How fast should IV phenytoin be administered? Slowly, 50 mg/min to reduce hypotension risk What are two adverse effects for ondansetron? HA and urinary retention What drug turns urine red-orange Phenazopyridine What is phenazopyridine? a urinary analgesic that discolors the urine (dark orange/red) -AKA Pyridium What is an adverse effect of ciprofloxacin? Can cause tendinitis and tendon rupture. Monitor and report tendon pain or inflammation What should you rinse your mouth with after inhaling with a metered dose inhaler (MDI)? TAP WATER *Mouthwash can further dry the mouth What are some teaching points for a client with a new prescription for a metered dose inhaler (MDI)? -Shake inhaler for vigorously 3-5 seconds after inserting canister to mix med thoroughly -Rinse mouth with TAP WATER after inhaling med (med can cause irritation to the mucosa, mouth wash can further dry the mouth) -Only need to wait 20-30 seconds between inhalations of receiving more than one inhalation of med How do oral contraceptives affect menstrual-associated migraine headaches? Decrease frequency How do oral contraceptives affect pelvic inflammatory disease, benign breast disease? Decrease risk A nurse is caring for a client who received an injection of penicillin G procaine. The client begins to experience dyspnea and tongue swelling. What action should the nurse perform first? Administer epinephrine subcutaneously. ABCs-it will act on adrenergic receptors, causing bronchodilation of the lungs and an elevation of BP (it stimulates both alpha and beta adrenergic receptors, accomplishing for anaphylaxis goals than any other therapy (vasoconstricts tongue swelling and opens lungs for dyspnea)) What is an adverse effect of finasteride? Decreased libido b/c of androgenic effect on prostate A nurse is preparing to administer an IM injection of meperidine to a client. What is the priority assessment the nurse should complete? RR. Meperidine can cause respiratory depression What is meperidine (Demerol)? Narcotic used for moderate-severe pain What does the erythrocyte sedimentation rate (ESR) measure? Inflammation What is finasteride used for? treats benign prostatic hypertrophy and also helps reduce the risk of prostate cancer. What is cyclophosphamide used for? treats leukemia, multiple myeloma, lymphomas, and head, ovary, breast, and lung cancer. What is leuprolide used for? treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require A client is taking bacizumab for metastic colorectal cancer. What is an adverse effect and what should be done? Nosebleeds. Should be reported to provider b/c client has an increased risk when taking this medication for severe bleeding from nosebleeds, vaginal bleeding, GI bleeding, intracranial bleeding and pulmonary bleeding, which may be caused from the development of thrombocytopenia and other blood disorders. How does a high-fat meal affect absorption of sildenafil? It delays the absorption How far in advance should sildenafil be taken prior to sexual activity? 1 hr A nurse is caring for a client who is prescribed diphenhydramine to relieve pruritis. The client asks the nurse how he can minimize the daytime sedation he is experiencing. What should the nurse teach? Take most of the daily dose at bedtime. Allows client to obtain maximum relief of manifestations and rest without itching. A nurse is providing teaching to a client who has open-angle glaucoma and a new treatment regimen of timolol and pilocarpine eye drops. What instruction should be given? Hold pressure for 1-2 min on the lacrimal sac following drop administration. The action prevents excessive systemic absorption of the meds How long after ophthalmic meds are administered should contacts be put back in? 15 minutes If more than one opthalmic med is to be administered, how far apart should they be given? 5 minutes A nurse is teaching a client who is taking metformin XR for type II diabetes mellitus. What instruction should the nurse give? Take the medication with a meal (to avoid hypoglycemia and GI upset, and to provide the most absorption of the med) How soon should alteplase be administered in accordance with client's arrival to ED? Within 30 minutes What must be done to alteplase before it can be administered? Reconstitute med with sterile water. Alteplase is available as a powder and must be reconstituted with water to be given. How is alteplase administered? An accelerated, or loading dose, to promote a rapid therapeutic effect of the med What are the indications of bleeding? -Back pain -HA -Changes in level of consciousness -Decreased Hct and Hgb A nurse is caring for a client who has schizophrenia and is taking haloperidol. What adverse effect should the nurse monitor for? Extrapyramidal symptoms include movement disorders If a client is experiencing Cushing's Triad, what does that indicate? Client is experiencing increased intracranial pressure. Nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema When do blood transfusion reactions occur and what is the nursing implication? Often within the first 50 mL of the transfusion. So, nurse should remain with client for first 15-30 minutes of transfusion When on warfarin, what safety measure should a patient take when shaving? Use an electric razor to decrease risk for injury and bleeding How should a client handle mild nosebleeds when on warfarin? Stop the med and notify provider of bleeding A nurse is teaching for a client who is to begin taking tamoxifen to treat breast cancer. The nurse should instruct the client to expect what adverse effect? Hot flashes b/c it is an antiestrogen med that blocks estrogen receptors Proton pump inhibitors can cause what adverse effect? Headaches A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should monitor for what adverse reactions? Constipation (so increase fluid and fiber) A nurse is teaching a client who is to begin long-term therapy with prednisone to treat rheumatoid arthritis. The nurse should instruct the client to take what supplements? Calcium and Vit D b/c long-term glucocorticoids place client at risk for osteoporosis How does furosemide affect potassium levels? Lowers them-Hypokalemia