NCLEX-RN MUST KNOW MEDICATIONS

NCLEX-RN MUST KNOW MEDICATIONS 1 P H A R M A C O L O G Y F O R T H E N C L E X - R N MUST KNOW DRUGS 2 ALTEPLASE • MOA – thrombolytic – plasminogen activator – • Indications – MI – Acute ischemic stroke – Occluded Central lines 2 • Nursing Considerations – Contraindicated in active bleeding – Monitor for active bleeding (q15m x 1hr; q15-30m x 8hr) – May cause intracranial hemorrhage – Monitor for anaphylaxis – Use caution with uncontrolled hypertension – Assess neuro status during therapy • 3 A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient’s cardiac enzymes are pending. The nurse caring for this patient will expect to: A. administer aspirin when cardiac enzymes are completed. B. give alteplase [Activase] within 2 hours. C. give tenecteplase [TNKase] immediately. D. obtain an order for an INR. 4 A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient’s cardiac enzymes are pending. The nurse caring for this patient will expect to: A. administer aspirin when cardiac enzymes are completed. B. give alteplase [Activase] within 2 hours. C. give tenecteplase [TNKase] immediately. D. obtain an order for an INR. 5 ATORVASTATIN • MOA – HMG-CoA reductase inhibitor – lipid lowering agent – • Indications NCLEX-RN Mus5t Know Medications 1 – • Indications – Management of hypercholesterolemia (primary prevention of cardiovascular disease) 2 • Nursing Considerations – Contraindicated in active liver disease – May cause rhabdomyolysis – Monitor renal function – Monitor serum cholesterol before treatment and 4 weeks after starting therapy – Monitor LFTs – Instruct patient to report muscle weakness (sign of rhabdomyolysis) 6 A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina. The patient’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What will the nurse expect the provider to order for this patient? A. An antihypertensive medication B. Counseling about a weight loss diet C. Discontinuing the ACE inhibitor D. High-dose statin therapy 7 A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina. The patient’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What will the nurse expect the provider to order for this patient? A. An antihypertensive medication B. Counseling about a weight loss diet C. Discontinuing the ACE inhibitor 8 D. High-dose statin therapy ACETAMINOPHEN • MOA – non-opioid analgesic – prostaglandin inhibitor – • Indications – Pain – Fever 2 • Nursing Considerations – Do not exceed 4g of acetaminophen per day to limit risk of renal, liver and cardiac damage Overdose will lead to hepatotoxicity damage – Overdose will lead to hepatotoxicity – Acetylcysteine (acetadote) is the antidote for overdose – May increase the risk for bleeding with warfarin therapy – May alter blood glucose measurements • 9 A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications? A. Acetaminophen B. Aspirin C. Ibuprofen D. Morphine 10 A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications? A. Acetaminophen B. Aspirin C. Ibuprofen D. Morphine 11 ACYCLOVIR • MOA – antiviral – purine analogue – • Indications – Genital herpes – Herpes zoster – Chicken pox 2 • Nursing Considerations – May cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea – Monitor renal panel during administration – Assess lesions during therapy – Instruct patient to use proper protection during sexual intercourse • 12 The nurse is caring for a patient receiving intravenous acyclovir. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: A. hydrate the patient during the infusion and for 2 hours after the infusion. 12 associated with intravenous acyclovir, the nurse will: A. hydrate the patient during the infusion and for 2 hours after the infusion. B. increase the patient’s intake of foods rich in vitamin C. C. monitor urinary output every 30 minutes. D. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. 13 The nurse is caring for a patient receiving intravenous acyclovir. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: A. hydrate the patient during the infusion and for 2 hours after the infusion. B. increase the patient’s intake of foods rich in vitamin C. C. monitor urinary output every 30 minutes. D. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. 14 ALBUTEROL • MOA – bronchodilator – binds to Beta2 adrenergic receptors in airway leading to relaxation of the smooth airway muscles – • Indications – Airway obstruction – COPD – Asthma 2 • Nursing Considerations – May decrease effectiveness of beta blockers – Use with caution: heart disease, diabetes, glaucoma, seizure disorder – Overuse of inhaler can lead to bronchospasm – Monitor for chest pain and palpitations – Can increase digoxin levels • 15 A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medication is always effective. Which action is outside the nurse’s scope of practice? A. Asking the patient to demonstrate use of the inhaler B. Assessing the patient’s exposure to tobacco smoke C. Auscultating lung sounds and obtaining vital signs D. Suggesting that the patient use one puff to reduce side effects • 16 • 16 A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medication is always effective. Which action is outside the nurse’s scope of practice? A. Asking the patient to demonstrate use of the inhaler B. Assessing the patient’s exposure to tobacco smoke C. Auscultating lung sounds and obtaining vital signs D. Suggesting that the patient use one puff to reduce side effects • 17 ALEDRONATE • MOA – biphosphnate – inhibits osteoclast activity leading to inhibition of resorption of bone – • Indications – Osteoporosis (aging, menopause, corticosteroid induced) 2 • Nursing Considerations – Take first thing in the morning with full glass of water 30 mins prior to eating – Assess serum calcium and vitamin D – May lead to muscle pain • 18 ALPRAZOLAM • MOA – benzodiazepine – works in CNS to produce anxiolytic effect causing CNS depression – • Indications – Anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis 2 • Nursing Considerations – Use caution with existing CNS depression, sleep apnea, renal dysfunction, hepatic dysfunction – May cause CNS depression, drowsiness, lethargy – May lead to physical dependence, may experience tolerance effect – Assess anxiety and mental status – Flumazenil is antidote for overdose – Grapefruit juice may increase blood levels • 19 AMIODARONE • MOA – potassium channel blocker – class III antiarrhythmic – prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation NCLEX-RN Mu1Ksn9t ow Medications 1 adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation – • Indications – Ventricular arrhythmias, SVT – ACLS protocol for V-Fib and V-Tach 2 • Nursing Considerations – May lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension – Increases risk for QT prolongation – Increases digoxin levels – Increases activity of warfarin – Monitor EKG continuously while on therapy – Assess for signs and symptoms of ARDS – Monitor LFTs – Check dosage with another RN – Teach pt to monitor pulse daily and report abnormalities – Avoid drinking grapefruit juice 20 A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching? A. “I may have itching, malaise, and jaundice, but these symptoms will subside.” B. “I need to use sunblock to help keep my skin from turning bluish gray.” C. “I should not drink grapefruit juice while taking this medication.” D. “I should report shortness of breath and cough and stop taking the drug immediately.” 21 A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching? A. “I may have itching, malaise, and jaundice, but these symptoms will subside.” B. “I need to use sunblock to help keep my skin from turning bluish gray.” C. “I should not drink grapefruit juice while taking this medication.” D. “I should report shortness of breath and cough and stop taking the drug immediately.” 22 AMITRYPTILINE • MOA – tricyclic antidepressant – increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects – • Indications