OOH UTA NURS FINAL EXAM WITH COMPLETE SOLUTION

What are the 9 rights? - ANSWER 1)Right pt: name & DOB,2) Right dose, 3)Right form, 4) Right med 5) Right route, 6) Right time, 7) Right documentation, 8) Right to refuse, 9) Right reason 10) Right response evaluation What can help prevent med errors - ANSWER check med 3 times, use leading zeros, verify unclear orders with HCP. high alert medications - ANSWER must be checked by 2 nurses Bioavailability - ANSWER amount of drug available for use vs amount absorbed which route has highest bioavailabity - ANSWER IV considerations for older adults - ANSWER GI slower, body H20 decrease, fat increased, less protein production, less metabolism of meds,less GFR & # of working nephrons. Usually on mulitple meds (polypharmacy) How does decreased protein, effect protein binding? - ANSWER More free drug and risk of toxicity Albumin - ANSWER 3.5-5.5 g/dL Potassium (K+) - ANSWER 3.5-5 mEq/L CYP 450 enzyme? Inducer: - ANSWER liver metabolic too quickly need bigger dose or more frequently = nicotine CYP 450 enzyme? Inhibitor food: - ANSWER slow metabolism, longer half life, smaller doses increases toxicity = grapefruit. CYP 450 enzyme? Inhibitor med: - ANSWER Cimetidinepharmacogentics - ANSWER diverse reaction to different meds based on genetics What are cultural considerations for African-Americans? - ANSWER Anti-hypertensives do not work well, Ca+ channel or combo of meds works best What is PCA? - ANSWER pt control analgesia, only pt administer, high alert med (morphine), check time limit, pt still needs monitoring: HR, RR, pulse ox What is the major adverse effect of acetaminophen? - ANSWER hepatotoxicity and Liver necrosis What is the antidote of Acetaminophen? - ANSWER Acetylcysteine better by IV b/c faster and rotten egg smell How do you identify chronic hepatotoxicity? - ANSWER Lab values elevated liver enzymes ALT & AST Recommended daily dose of acetaminophen - ANSWER 4000 acute via IV fda, 3000 daily manufacture, 2000 or none liver pt Most common NSAID adverse effect? - ANSWER GI ulcer & GI bleeding Who should not receive NSAID? - ANSWER pt w/ GI ulcer Black box warning for NSAID except aspirin - ANSWER black box for MI & CVA What does aspirin help prevent? - ANSWER MI & CVA Contraindication for ibuprofen & ketorolac - ANSWER Nephrotoxicity then Renal disease & Pregnancy What type of med is celecoxib? - ANSWER Only inhibits COX 2 to protect stomach lining celecoxib has more risk of? - ANSWER greater risk of MI & CVA than other NSAIDs What is contraindication for cholinergic meds? - ANSWER COPD and Asthma because of bronchoconstrictions, HTN, bradycardia, bowel and urinary obstruction,parkinson, peptic ulcers Cholinergic drugs known as? - ANSWER Rest and digest simulate PNS What is bethanechol use to treat? - ANSWER Post op urinary retention What is Pyridostigmine used for? - ANSWER Myasthenia gravis muscle weakness How do you evaluate Pyridostigmine? - ANSWER Muscles are stronger ( effectively breath and cough, swallow food) What S&S of a positive Tensilon test(Edrophonium)? - ANSWER reverse weakness quickly. Med is short acting. Eyelids are less droopy Atropine - ANSWER Cholinergic antidote Systematic bradycardia w/ low BP, diaphoresis, unconscious..Pre-op to dry secretions for surgery..Antidote for insecticides cholinergic crisis s&s - ANSWER DUMBELLS (diarrhea, urination, miosis, bradycardia, emesis, lethargy, lacrimation( tears) salivation) Scopolamine - ANSWER Motion sickness(patch), prevent post op N&V, hospice death rattle. Drys secretions Tolterodine - ANSWER Overactive bladder anti-cholinergic overdose(toxcity) - ANSWER madd as hatter( confusion), red a beet(redness), dry as bone( no sweating and dry mouth), blind as a bat (not for glaucoma pt), hot as a heir (fever), full as flask(urinary retention) Anticholinergic effects - ANSWER (the can'ts) can't see can't spit can't peecan't poo What is physostigmine use? - ANSWER Antidote for anti-cholinergic. Only for extreme CNS effects delirium, hallucinations, coma How to evaluate anti-parkinsons meds? - ANSWER improved gait, less tremors, less ridge, improve mask face, improved posture End of dose phenomenon (on-off) - ANSWER Med ware