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

Exam (elaborations) NRSG 2030 ATI PROCTORED EXAM REMEDIATION PHARMACOLOGY FINAL (COMPLETE AND THOROUGH) 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 a. Have = Desired Quantity X iii. EXPECTED ACTIONS/OUTCOMES 1. GROWTH FACTORS: EVALUATING CLIENT RESPONSE a. Depending on therapeutic intent, effectiveness can be evidenced by Hgb level of 10 to 11 g/dL and maximum Hct of 33%. 2. MEDICATIONS AFFECTING CARDIAC RHYTHM: VENTRICULAR DYSRHYTHMIA a. Procainamide CLASS IA b. Lidocaine CLASS IB c. Propafenone CLASS IC 3. ANTILIPEMIC AGENTS: DETERMINING AFFECTIVENESS OF TREATMENT a. Primary hypercholesterolemia b. Prevention of coronary events (primary and secondary) c. Protection against myocardial infarction (MI) and stroke for clients who have diabetes mellitus d. Increasing levels of HDL in clients who have primary hypercholesterolemia e. Primary prevention in clients who have normal LDL 4. MYCOBACTERIAL, FUNGAL, AND PARASITIC INFECTIONS: EVALUATING USE OF ANTI-INFECTIVE MEDICATIONS a. Usually administered orally. When given IM, warm to room temperature to ensure that the solution is free of crystals, and inject deeply into a large muscle. b. For active tuberculosis, direct observation therapy is done to ensure adherence. c. Advise clients to take isoniazid 1 hr before or 2hr after meals. If gastric discomfort occurs, the client can take isoniazid with meals. d. Instruct clients to complete the prescribed course of antimicrobial therapy, even though manifestations can resolve before the full course is completed 5. MEDICATIONS AFFECTING URINARY OUTPUT: THERAPEUTIC EFFECT OF FUROSEMIDE a. 6. MEDICATIONS AFFECTING LABOR AND DELIVERY: PRIORITY ACTION FOR A CLIENT RECEIVING OXYTOCIN a. 7. ADVERSE EFFECTS, INTERACTIONS, AND CONTRAINDICATIONS: PRIORITY TREATMENT FOR ANAPHYLAXIS a. 8. ENDOCRINE DISORDERS: ID A NEED FOR A DOSAGE INCREASE OF LEVOTHYROXINE a. 9. URINARY TRACT INFECTIONS: EVALUATING CLIENT RESPONSE TO AN ANALGESIC a. 10. CARDIAC GLYCOSIDES AND HEART FAILURE: ASSESSING FOR DIGOXIN TOXICITY a. Dysrhythmias, cardiotoxicity i. Dysrhythmias caused by interfering with the electrical conduction in the myocardium) ii. Cardiotoxicity leading to bradycardia GI EFFECTS Include anorexia (usually the first manifestation of toxicity), nausea, vomiting, and abdominal pain b. CNS effects Include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos aroundobjects) iv. MEDICATION ADMINISTRATION 1. MEDICATIONS AFFECTING COAGULATION: SELF ADMINISTRATION OF ENOXAPARIN a. Parenteral anticoagulants are contraindicated in clients who have low platelet counts (thrombocytopenia) or uncontrollable bleeding. b. These medications should not be used during or following surgeries of the eye(s), brain, or spinal cord; lumbar puncture; or regional anesthesia. c. Use cautiously in clients who have hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic or kidney disease, or threatened abortion. 2. ANGINA: CLIENT TEACHING FOR A NEW PRESCRIPTION OF SUBLINGUAL NITROGLYCERIN a. Place the tablet under the tongue and allow it to dissolve. b. Store tablets in original bottles, and in a cool, dark place. c. Spray translingual spray against oral mucosa and do not inhale 3. AIRFLOW DISORDERS: THERAPEUTIC ACTION OF MONTELUKAST a. Long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm b. Montelukast is used in children as young as 12 months of age. c. Zafirlukast is used in children age 5 years and up. d. Zileuton is used in adolescents and adults. 4. MEDICATIONS AFFECTING BLOOD PRESSURE: TITRATING CONTINUOUS NITROPRUSSIDE INFUSION a. Use cautiously with clients who have heart failure. Doses are started very low and titrated to the desired level. 5. SAFE MEDICATION ADMINISTRATION AND ERROR REDUCTION: REVIEWING A MEDICATION ADMINISTRATION RECORD a. Verify clients’ identification before each medication administration. The Joint Commission requires two client identifiers. b. Acceptable identifiers include the client’s name, an assigned identification number, telephone number, birth date, or another person-specific identifier, such as a photo identification card. c. Check identification bands for name and identification number. d. Check for allergies by asking clients, looking for an allergy bracelet or medal, and reviewing the MAR. e. Use bar-code scanners to identify clients. 6. MEDICATION AFFECTING COAGULATION: MONITORING LABORATORY RESULTS FOR WARFARIN ADMINISTRATION a. Obtain baseline prothrombin time (PT), and monitor levels of PT and international normalized ratio (INR) periodically. 7. DIABETES MELLITUS: EVALUATING UNDERSTANDING OF INSULIN SELF ADMINISTRATION a. Insulin is used for glycemic control of diabetes mellitus (type 1, type 2, gestational) to prevent complications. b. Clients who have type 2 diabetes mellitus can require insulin when: Oral antidiabetic medications, diet, and exercise are unable to control blood glucose levels. Severe renal or liver disease is present. Painful neuropathy is present. Undergoing surgery or diagnostic tests. Experiencing severe stress such as infection and trauma. Undergoing emergency treatment of diabetes ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome. Requiring treatment of hyperkalemia 8. ANTIBIOTICS AFFECTING PROTEIN SYNTHESIS: UNDERSTANDING TEACHING ABOUT TETRACYCLINE a. Tetracyclines are Pregnancy Risk Category D. b. Taking tetracyclines after the fourth month of pregnancy can stain the deciduous teeth, but they do not affect permanent teeth. They do, however, stain the permanent teeth of children between the ages of 4months and 8 years who take them. c. Use cautiously with liver and kidney disease. Doxycycline and minocycline are generally safe for clients who have kidney disease, because the liver, not the kidneys, eliminates these two tetracyclines. d. Interaction with milk products, calcium and iron supplements, laxatives containing magnesium, and antacids causes formation of nonabsorbable chelates, thus reducing the absorption of tetracyclines 9. ANTIBIOTICS AFFECTING THE BACTERIAL CELL WALL PROPER INJECTION TECHNIQUE a. It is important to administer nafcillin IM into a deep muscle mass, such as the ventrogluteal site. b. it is important to ask the client about an allergy to penicilli