NRSG 2030 ATI PROCTORED EXAM REMEDIATION PHARMACOLOGY FINAL (COMPLETE AND THOROUGH) (NRSG2030)

Exam (elaborations) NRSG 2030 ATI PROCTORED EXAM REMEDIATION PHARMACOLOGY FINAL (COMPLETE AND THOROUGH) (NRSG2030) ATI PROCTORED EXAM REMEDIATION CAIT BLACKFORD PHARMACOLOGY II DR. PHILLIPS 1. SAFETY AND INFECTION CONTROL a. ACCIDENT/ERROR/INJURY PREVENTION i. SAFE MEDICATION ADMINISTRATION AND ERROR REDUCTION: ADMINISTERING PHENYTOIN 1. Undesirable interaction is giving omeprazole, a proton pump inhibitor, concurrently with phenytoin, an anticonvulsant. This can increase the serum level of phenytoin. Obtain a complete medication history, and be knowledgeable of clinically significant interactions. Be aware that medications can also interact beneficially or harmfully with food and with herbal and dietary supplements ii. ANTIBIOTICS AFFECTING THE BACTERIAL CELL WALL: PRIORITY FINDING AFTER A PENICILLIN INJECTION 1. Instruct clients to take penicillin V, amoxicillin, and amoxicillin-clavulanate with meals. Tell them to take all others with 8 oz of water 1 hr before or 2 hr after meals. Instruct clients to report any signs of an allergic response such as dyspnea, a skin rash, itching, and hives. Give IM injections cautiously to avoid injecting into a nerve or an artery. Advise clients to complete the entire course of therapy, even if symptoms resolve. Advise client to use an additional contraceptive method when taking penicillin’s. iii. REPORTING OF INCIDENT/EVENT/IRREGULAR OCCURRENCE/VARIANCE 1. SAFE MEDICATION ADMINISTRATION AND ERROR REDUCTION: PRIORITY ACTION FOR INCORRECT MEDICATION DOSAGE a. Use a unit-dose system to decrease errors. If not available, calculate the correct medication dose. Check a drug reference to ensure the dose is within the usual range. When performing medication calculations or conversions, have another qualified nurse check the calculated dose. Prepare medication dosages using standard measurement devices, such as graduated cups or syringes. Some medication dosages require a second verifier or witness, such as some cytotoxic medications. Automated medication dispensing systems use a machine to control the dispensing of medications. 2. SAFE MEDICATION ADMINISTRATION AND ERROR REDUCTION: INDENTIFY A SITUATION REQUIRING AN INCIDENT REPORT a. Report all errors, and implement corrective measures immediately. Complete an incident report within the time frame the facility specifies, usually 24 hr. This report should include ■Client’s identification ■Name and dose of the medication ■Time and place of the incident ■Accurate and objective account of the event ■Who you notified ■What actions you took ■Your signature (or that of the person who completed the report) Do not reference or include this report in the client’s medical record. Medication errors relate to systems, procedures, product design, or practice patterns. Report all errors to help the facility’s risk managers determine how errors occur and what changes to make to avoid similar errors in the future. 3. MISCELLANEOUS CENTRAL NERVOUS SYSTEM MEDICATIONS: TREATMENT FOR MUSCARINIC POISONING a. Extreme muscarinic stimulation can result in increased gastric acid secretion, abdominal cramps, diarrhea, sweating, tearing, urinary urgency, bradycardia and hypotension; bronchoconstriction b. NURSING CONSIDERATIONS ●Instruct clients to report adverse effects if they occur. Monitor for bradycardia and hypotension. ●Administer on an empty stomach to reduce effects. 2. PSYCHOSOCIAL INTEGRITY a. CHEMICAL AND OTHER DEPENDENCIES/SUBSTANCE USE DISORDER i. SUBSTANCE USE DISORDERS: TREATMENT FOR COCAINE TOXICITY 1. 3. PHARMACOLOGICAL AND PARENTERAL THERAPIES i. ADVERSE EFFECTS/CONTRAINDICATIONS/SIDE EFFECTS/INTERACTIONS 1. MYCOBACTERIAL, FUNGAL, AND PARASITIC INFECTIONS: INTERPRETING SIDE EFFECTS OF RIFAMPIN a. Rifampin accelerates metabolism of warfarin, oral contraceptives, protease inhibitors, and non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV, resulting in diminished effectiveness. b. NURSING CONSIDERATIONS ● Increased dosages of HIV medications are often necessary. ● Monitor PT and INR. ● Advise clients to use a non-hormonal form of contraception. 2. CHRONIC NEUROLOGIC DISORDERS: ADVERSE EFFECTS OF PHENYTOIN a. CNS effects ●Nystagmus, sedation, ataxia, double vision, cognitiveimpairment b. NURSING CONSIDERATIONS: Monitor for manifestations of CNS effects, and notify the provider if they occur. Gingival hyperplasia ●Softening and overgrowth of gum tissue, tenderness, and bleeding gums NURSING CONSIDERATIONS: Advise clients to maintain good oral hygiene (dental flossing, massaging gums). Folic acid supplements can decrease the occurrence. Skin rash c. NURSING CONSIDERATIONS: Stop medication if rashdevelops.Cardiovascular effects: dysrhythmias, hypotensionNURSING CONSIDERATIONS ●Administer at slow IV rate (no faster than 50mg/min) and in dilute solution to prevent adverse cardiovascular effects. ●Avoid administering to a client who has sinus bradycardia, sinoatrial block, or Stokes-Adams syndrome. Endocrine and other effects ●Coarsening of facial features, hirsutism, and interference with vitamin D metabolism d. NURSING CONSIDERATIONS- Instruct the client to report changes.-Encourage the client to consume adequate amounts of calcium and vitamin D. Interference with vitamin K-dependent clotting factors causing bleeding in newborns e. NURSING CONSIDERATIONS: Administer prophylactic vitamin K to the mother for 1month before the infant is delivered. 3. MISCELLANEOUS PAIN MEDICATIONS: ADVERSE EFFECTS OF ERGOTAMINE a. Gastrointestinal discomfort Such as nausea and vomiting b. NURSING CONSIDERATIONS: Administer an antiemetic, such as metoclopramide. Acute or chronic overdose (ergotism) c. ●Muscle pain, paresthesia’s in fingers and toes; peripheral ischemia NURSING CONSIDERATIONS: Stop medication, and immediately notify the provider if symptoms occur. d. Physical dependence NURSING CONSIDERATIONS ●Advise clients not to exceed the prescribed dose. ●Medication should not be taken daily on a long-term basis. ●Inform clients regarding symptoms of withdrawal (headache, nausea, vomiting, restlessness). ●Notify the provider if symptoms occur. e. Fetal harm or abortion NURSING CONSIDERATIONS ●Avoid using this medication during pregnancy. ●Advise clients to use additional contraception while using the medication. 4. MEDICATIONS AFFECTING BLOOD PRESSURE: ADVERSE EFFECTS OF ABRUPT PROPRANOLO WITHDRAWL a. The myocardium becomes sensitized to catecholamines with long-term use of beta-blockers. ●Advise clients not to stop taking beta-blockers abruptly, but to follow the provider’s instructions. ●Discontinue use of beta-blockers over 1 to 2 weeks. b. May cause rebound hypertension 5. MEDICATIONS EFFECTING COAGULATION: ADVERSE EFFECTS OF CLOPIDOGREL a. Bleeding i. Prolonged bleeding time, gastric bleed, thrombocytopenia b. NURSING CONSIDERATIONS ●Monitor bleeding time. ●Monitor for gastric bleed (coffee-ground emesis or bloody, tarry stools). ●Monitor for bruising, petechiae, and bleeding gums. ●Apply pressure to cardiac catheter access.GI effects (diarrhea, dyspepsia, pain) CLIENT EDUCATION: Teach the client to monitor for effects and notify the provider. 6. ANTIBIOTICS AFFECTING THE BACTERIAL CELL WALL: ALLERGIC REACTIONS TO CEPHALOSPORINS a. A history of severe allergic reactions to penicillin, cephalosporins, or imipenem is a contraindication for penicillins. b. Use cautiously for clients who have or are at risk for kidney dysfunction (clients who are acutely ill, older adults, or young children). c. Clients who are allergic to one penicillin are cross-allergic to other penicillins and are at risk for cross-sensitivity to cephalosporins 7. ENDOCRINE DISORDERS: ADVERSE EFFECTS OF THYROID HORMONE a. Overmedication can result in indications of hypothyroidism (drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia) 8. MEDICATIONS AFFECTING COAGULATION: LABORATORY RESULTS TO REPORT a. Obtain baseline and monitor complete blood count (CBC), platelet count, and hematocrit levels b. Discontinue medication for platelet count less than 100,000/mm3 9. ANTIBIOTICS AFFECTING PROTEIN SYNTHESIS: DIETARY SUPPLEMENT INTERACTIONS WITH TETRACYCLINE a. Instruct clients to take tetracyclines (except for minocycline) on an empty stomach with 8 oz water. It may be taken with food if gastric distress occurs. b. Tell clients not to take tetracyclines just before lying down because it increases the risk of esophageal ulceration. c. Instruct clients to maintain a 2-hr interval between ingestion of chelating agents and tetracyclines. d. Instruct clients to complete the entire course of therapy, even though manifestations may resolve sooner. e. Advise using additional contraception. 10. IMMUNIZATIONS: CONTRAINDICATION FOR RECEIVING VARICELLA VACCINE a. Starting at age 2 years the live, attenuated influenza vaccine (LAIV) nasal spray can be used. LAIV is contraindicated for children age 2 to 17 years who are receiving aspirin-containing products, children age 2 to 4 years who have asthma or have had wheezing during the past year, or anyone who has taken an antiviral medication in the 48 hr prior to vaccine administration. ii. DOSAGE CALCULATION 1. DOSAGE CALCULATION: PREPARING EXOCAPARIN