Pharmacology Exit HESI Latest 2023 Complete Guide

Pharmacology Exit HESI Nurse should observe most closely for drug toxicity when a client receives med that has what characteristic Narrow therapeutic index The nurse should observe most closely for drug toxicity when a client receives a medication that has which characteristic? • Low bioavailability • Rapid onset of action • Short half life • Narrow therapeutic index. • Rationale: A drug with a narrow therapeutic index has a high risk for toxicity because there is a narrow range between the therapeutic dose and the toxic dose. Nurse is conducting DC teaching about anti-anxiety drug diazepam (valium) Evaluate the ingredients of all over-the-counter drugs for alcohol content Nursing instruction most important for patient on Zyloprim Increase fluid intake Client getting Tofranil (Imipramine) Give medication at night Magnesium antidote Calcium gluconate Patient with hyperthyroidism taking inderal (propanalol) Decreases pulse rate A client with hyperthyroidism is receiving propranolol (Inderal). Which finding indicates that the medication is having the desired effect? • Decrease in serum T4 levels • Increase in blood pressure • Decrease in pulse rate • Goiter no longer palpable Medication dosing-heparin 25000 units at 7ml/hr doctor changed rate to 900 units what is the Mls/hr Med was ordered 100mg in 4 divided doses in 24 hours available in 25mg, how many will you give every 6 hours 1 Patient on benzos Answer is not narcan - A client experiencing withdrawal from the benzodiazepines alprazolam (Xanax) is demonstrating severe agitation and tremors. What is the best initial nursing action? • Administer naloxone (Narcan) per PNR protocol • Initiate seizure precautions • Obtain a serum drug screen • Instruct the family about withdrawal symptoms. • Rationale: Withdrawal of CNS depressants, such as Xanax, results in rebound over-excitation of the CNS. Since the client exhibiting tremors, the nurse should anticipate seizure activity and protect the client. Patient Dx with bipolar-how to know if meds are effective Family states patient is doing better with manic phases - A client with bipolar disorder began taking valproic acid (Depakote) 250 mg PO three times daily two months ago. Which finding provides the best indication that the medication regimen is effective? •The family reports a great reduction in client’s maniac behavior Patient on Heparin going for surgery in a.m.,-priority Assess patient for bleeds Best time to give patient Abx (I think) Time was like 1000, 1400, 1200, and 0400…best to give around the clock Medication calculation-patient weighs equal to 16kg-order for Tamiflu 45mg BID Must round up-answer is 3.8ml Peptic ulcer med-what action Histamine 2 agonist Patient on folliculitis medication-what to teach Drink with full glass of water Vasopressin Vasoconstrictor Know why Digoxin and Lasix are used together - Someone's on digoxin and Lasix how do you know the meds are working; is it because potassium is at 4, magnesium or something else Tamoxifen Citrate use and therapeutic outcome - Breast cancer Fosomax for osteoarthritis patient teaching 1. A female client receives a prescription for alendronate sodium (Fosamax) to treat her newly diagnose osteoporosis. W /hat instruction should the nurse include in the client’s teaching plan? • Take on an empty stomach with a full glass of water Rifampin for TB Rusty-orange/red colored urine and body fluids Pyridium for bladder infection Orange/red/pink urine Stay in bed for 3 hours post first Ace Inhibitor dose Avoid grapefruit juice with CCB Lipitor (statins) in PM only-no grapefruit juice Trough draw - A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? A) Sixty minutes after the antibiotic dose is administered. B) Immediately before the next antibiotic dose is given. C) When the next blood glucose level is to be checked. D) Thirty minutes before the next antibiotic dose is given. - Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given (B). (A, C, and D) do not describe the optimum time for obtaining a trough level of an antibiotic. Peak draw 30-60 minutes after administration Potassium sparing diuretic need to watch for hyperkalemia Aldactone (spirinolactone) Using bronchodilators before steroids for asthma teaching Exhale completely, inhale deeply, hold breath for 10 seconds Insulin can be kept at room temp 28 days Drawing insulin Clear (regular) first then cloudy (NPH) Know the insulins and their peak/onset (there are several Qs about this in different formats) Rapid-Lispro (Humalog) and Aspart (Novolog) Onset: 5-15 minutes Peak: . 5-1.5 hours Short acting- regular (humulin) Onset: 30-60 minutes Peak: 2-3 hours (IV ok) Intermediate acting- NPH Onset: 1-2 hours Peak 6-12 hours Long acting- Glargine (lantus) Onset: 1.1 hour Peak: 14-20 hours (DO NOT MIX) Chlamidia Tetracycline Trichomoniasis Flagyl Candidiasis Nystatin Herpes Simplex 2 Acyclovir Parkinson’s disease Levodopa/Carbidopa Phenobarbitol Seizures Preparing to administer a drug to a pt with an infection The drug will destroy the microorganism RN is teaching a pt about a new drug… what’s most important to teach the pt to improve the intensity of the response to the drug Take the prescribed dose A nurse is giving morphine 2 mg IV to a pt after surgery and she has followed the “six rights of administration”… Know the possible reactions to morphine RN doesn’t understand why a pt is to receive a prescribed med Verity the reason with the prescribing healthcare provider for use Administration of schedule IV drug, the RN understands The drug has acceptable medical application with low potential for abuse - A nurse is administering a drug that is categorized as Schedule IV. The nurse understands that this means the drug: A. Has acceptable medical applications with low potential for abuse B. Is a controlled sub with no accepted medical use C. Is dangerous to admin to pregnant or breast-feeding pts D. Has the potential for serious and life-threatening adverse effects Where would a RN direct a pt to obtain more info about prescribed medications A pharmacist RN is prepared to administer Epinephrine to pt that has a severe allergic reaction IV – no first pass effect Digoxin has 36-48 hr half life – because of the length of half life, the RN expects to be dosing this medication Once a day Pt is prescribed Cimetidine (histamine 2 antagonist) to treat gastric ulcer Inhibit the action of histamine at receptor sites and block gastric acid secretion - When teaching a patient who has a gastric ulcer about cimetidine (a histamine H2 antagonist) therapy, the nurse should include which information about antagonists A. An antagonist causes a chemical reaction in the stomach B. An antagonist activates receptors in the stomach lining C. An antagonist prevents receptor activation in the stomach D. An antagonist improves receptor sensitivity in the stomach Drug X has a therapeutic index of 10 and drug Y has an index of 2 Drug Y – more potent A pt taking Digoxin is also prescribed Propanolol. The 2 drugs combined may cause a serious decrease in HR An increased adverse effect A pt prescribed CCB Diltiazem to treat hypertension Grapefruit juice - The nurse cares for a patient taking a calcium channel blocker for hypertension. The nurse is most concerned if the patient makes which statement? "I drink a glass of grapefruit juice each evening" Which of the pts would be at highest risk for an adverse reaction An 84 yo with diabetes, HF, hypertension and takes 8 medications per day RN receives a handwritten medication order – can’t read Contact prescriber to clarify order A breast-feeding pt is prescribed an antimicrobial medication Take immediately after breast-feeding The RN is evaluating the kidney fx of an 82 yo pt before administration of medications – Creatinine clearance – a measure of how the kidneys are fx by excreting creatinine. (BUN – good indicator of volume and dehydration) (Creatinine – is reflective very much by your BUN or level of hydration) The most important factor in an adverse drug reaction in the elderly population is Declining renal fx A pt is prescribed Bethanocol (Muscarinic Agonist) for urinary retention – if pt exhibits signs of overdose such as: increased salivation, sweating, bradycardia, hypotention, the RN would administer Atropine (anticholenergic – makes us dry) The pt takes Oxybutinin (anticholenergic) for OOB takes an OTC antihistamine (anticholenergic) for hay fever Dry mouth, increased temp, and blurry vision (myosis) After IM injection of penicillin the pt develops severe difficulty breathing and swollen tongue (Anaphylaxis) Administer epinephrine A pt receives Dopamine for shock (hypotention, vascular collapse, comatose) Mean arterial pressure Pt receives a drug that blocks adrenergic receptors Orthostatic hypotension (no BP to the brain) Reflex tachacardia is caused by hypotention A pt with diabetes gets a beta blocker (mask the signs of hypoglycemia and blocks beta receptors – inhibits glycogenolysis) Atenolol (more selective) A pt with depression is prescribed an antidepressant – the medication will reach full therapeutic effect 2 to 3 weeks (more like 1 to 2 months but this is the best response) A pt taking Levadopa/Carbadopa (dopaminergic) and experiences a frequent “on – off” episodes Avoid high protein meals – competes with drug A pt is prescribed a Dopamine agonist (Mirapex) (adrenergic agonist) for Parkinson’s “This med will stop the progression of Parkinson’s.” – can’t cure Parkinson’s Pt with mild symptoms of Alzheimer’s is prescribed Donepezil (Aricept) The drug will stop the damage to the neurons in my brain - A patient with mild symptoms of Alzheimer's disease is prescribed donepezil (Aricept). Which statement made by the patient indicates a need for further teaching? - "The drug will stop damage to the neurons in my brain." **Donepezil will improve transmission by neurons in the brain because more acetylcholine will be availalble (it is a cholinesterase inhibitor), it may cause an upset stomach, and it is a good idea to take it at bed time because of the side effects. It will not, however, stop the damage in the brain, it only provides symptom control.** Pt is concerned about developing Alzheimer’s disease Naproxen (NSAID’s) Which assessment best determines the effectiveness of Sumatriptan (triptans are used for treatment of Migraines so… Termination of the migraine Pt with schizophrenia is prescribed chlorpromazine (Thorazine – first generation antipsychotic) oral concentrate The medication may cause excessive salivation - A patient with schizophrenia is prescribed chlorpromazine (Thorazine) oral concentrate. Which of the following discharge instructions should the nurse complete? A. Sexual arousal may be enhanced with this medication. B. Avoid direct skin contact with the medication. C. The medication may cause excessive salivation. D. Do not limit salt intake while taking the medication. Which assessment best determines the pt is developing tardive dyskinesia Twisting, writhing, worm-like movements of tongue Pt with depression is proscribed Fluoxitine (Prozac) “It may take 3-4 weeks before my mood is elevated” Pt is on Marplan (MAOIs – have the most food interactions) for depression Bananas, smoked fish, and cheese Pt on Lithium Polydypsia (increased thirst), slurred speech, and fine hand tremors Pt is prescribed Lunesta for insomnia Anterograde amnesia (memory loss of events right before taking drug) A 24 yo female gets Triazolam (Halcion) for insomnia at home (remember to use the process of elimination) “The medication will not alter my breathing” A pt is prescribed Venlafaxine and the pt asks what the purpose of medication is, you should state Depression and anxiety A pt with OCD is prescribed Zoloft – which is not a true statement about the medication “I will get better in 3 weeks.” (full effect in 1 – 2 months, you won’t get “better” necessarily) An RN is teaching a parent about administration of adderall to treat their child’s ADD Give the dose in the morning b4 school. (amphetamine – child needs it to concentrate) Amphetamines can cause growth suppression in children Provide snack or meal b4 giving med (because amphetamines suppress appetite) Pt states that he’s on Oxycodone and the dose that he currently receives does not provide the same pain relief Tolerance A pt with HF is getting Furosemide (Lasix) (loop diuretic is K+ wasting) Oranges, spinach, and potatoes high in potassium A client in renal failure asks why he is being given antacids Calcium and aluminum antacids bind phosphates and help to keep phosphates from being absorbed into blood stream thereby preventing rising phosphate levels, and must be taken with meals