NURS 270 Midterm 2023 with verified questions and answers

Enteral medications tablets, capsules, pills, time-released capsule Parenteral medications injectable forms, solutions, powders for reconstitution Topical medications ointments, pastes, powders, inhalations, transdermal patches What medication route has a constant rate of absorption that can last 1-7 days? transdermal patches acute pain pain that is sudden and usually subsides when treated chronic pain persistent or recurring pain; often difficult to treat somatic pain pain from skeletal muscles, ligaments, or joints visceral pain pain from organs or smooth muscles superficial pain pain from skin or mucous membranes vascular pain pain that is thought to account for most migraine headaches neuropathic pain pain results from injury or damage to peripheral nerve fibers phantom pain pain relating to a body part that has been removed central pain pain that occurs with tumors, trauma, or inflammation of the brain To decrease the possibility of a headache after spinal anesthesia, the nurse will provide what instruction to the patient? maintain strict bedrest When the effects of local anesthetics begin to wear off, which physiologic response is the first to occur? motor activity returns When a patient receives a neuromuscular block, what order do the areas become paralyzed in? 1st: small, rapidly moving muscles (fingers, eyes) 2nd: limbs, neck, trunk muscles 3rd: intercostal muscles and diaphragm What is a possible systemic effect of excessive usage of topically applied adrenergic nasal decongestants? palpitations What food allergies should be assessed for before giving an Atrovent inhaler? (ipratropium) soy products, peanuts When a patient has both a bronchodilator and a corticosteroid inhaler, which should be taken first? take the bronchodilator inhaler first If a patient is experiencing status asthmaticus, what medication will the nurse administer first? Why? epinephrine; it is a potent bronchodilator What antihistamine does not cause drowsiness? loratidine (Claritin) A patient complains about daytime drowsiness after taking Benadryl. What might the nurse say to her? "This drug often causes a 'hangover effect' during the day after taking it." What teaching should be given with an expectorant? drink extra fluids, unless contraindicated, to aid in expectoration of sputum What drug is a synthetic derivative of the major active substance in marijuana? What is it used for? Dranabinol (Marinol) n/v What are some facts about PPIs? 1. take 30-60min before meals 2. they can be used as part of H. pylori infection treatment 3. there are very few adverse effects with these drugs What kind of antacids are contraindicated in patients with renal failure? calcium-containing antacids magnesium-containing antacids What kind of antacids might a nurse suggest for patients with renal failure? aluminum-containing antacids sodium-based antacids What might a nurse say to a patient who has been having diarrhea from a PEG-3350 bowel prep for the last 45 minutes? "It may take 4 hours to completely evacuate the bowel." Rapid-acting insulin onset, peak, and duration (Lispro) onset: 15-30min peak: 30min-2.5hrs duration: 3-6hrs Short-acting insulin onset, peak, and duration (Regular) onset: 30min-1hr peak: 1-5hrs duration: 6-10hrs Intermediate insulin onset, peak, and duration (NPH) onset: 1-2hrs peak: 6-14hrs duration: 16-24hrs Long-acting insulin onset, peak, and duration (Insulin Glargine) onset: 1.5hr peak: none duration: up to 24hrs What kind of insulin can be given IV? regular Why are all insulin vials (except for regular insulin) rolled prior to administration? to mix it When is Insulin Glargine given? at night Early and later signs/symptoms hypoglycemia early: irritability, confusion, tremors, sweating later: hypothermia, seizures In what order does a patient use the drug Flonase (fluticasone)? 1. prime inhaler prior to first use 2. clear nose by blowing 3. instill one spray directed high into nasal cavity 4. spit out any excess liquid that drains into mouth Which instructions should be included with teaching a client about the use of dextromethorphan with guaifenesin for a cough accompanied by thick mucus? avoid drinking fluids immediately after the syrup, but increase overall fluid intake throughout the day What adverse effect should the nurse monitor for in a patient prescribed aminophylline-theophylline? increase HR What should be done if a nurse finds a patient who is receiving aminophylline to have a serum theophylline level of 32 mcg/mL. Why? Notify the healthcare provider of the level; serum theophylline 20mcg/mL are considered toxic What are some possible side effects of bronchodilators? nervousness, tremors, palpitations What drug acts by blocking leukotrienes, thus reducing inflamation in the lungs? montelukast (Singulair) What type of inhaled asthma drug has anti-inflammatory effects? corticosteroids What type of asthma drug is used to prevent flare-ups? corticosteroids Why is simethicone (Gas X, Mylicon) given? decreases the amount of gas associated with GI disorders What should a nurse recommend to a patient who has been taking omeprazole (Prilosec) over the past 6 months for treatment of epigastric pain, yet still reports pain? check with the healthcare provider about his continued discomfort because there may be an underlying cause of pain What drug can be used for rapid relief of constipation? magnesium hydroxide (Milk of Magnesia) What are some non-pharmacologic methods to decrease n/v? 1. provide client with weak tea to drink 2. sip carbonated beverages 3. provide client with gelatin to eat (considered liquid) What is the action of emollients in the intestine? they cause water accumulation which softens and expands stool If a client is experiencing severe diarrhea, what should the nurse monitor for? 1. electrolytes 2. vitals 3. bowel sounds How much water should a client mix with a bulk-forming laxative? 8oz What should a client with myxedema check before taking levothyroxine (Synthroid)? their heart rate How should precose (Acarbose) be taken? with the first bite of a meal What are some signs that a client with hypothyroidism may need a higher dose of levothyroxine (Synthroid)? complaints of coldness, constipation What should the nurse instruct a patient with hyperthyroidism who has been given radioactive iodine (I-131) to avoid? avoid close contact with children for one week because radiation is present in the body What should the nurse monitor for in a patient receiving anti-thyroid medication? 1. thyroid function tests 2. weight 3. GI distress 4. vital signs 5. activity intolerance What laboratory test should be monitored to evaluate the success of long-term diabetes treatment? Hemoglobin A1c levels How can a patient reduce the insomnia associated with thyroid hormone replacement therapy? take the dose upon awakening in the morning When should a nurse give rapid-acting insulin to a hospitalized patient? 15 minutes before the patient begins a meal What is a condition that would contraindicate the use of inhaled insulin medication? chronic lung disease Which herb decreases the elimination of many drugs that are renally excreted? cranberry Which herb can increase the effects of barbiturates and alcohol? kava Which herb may interfere with hypoglycemic therapy and with the anticoagulant warfarin (Coumadin)? garlic Which herb can, at high doses, interfere with cardiac, anti-diabetic, or anticoagulant drugs? ginger root Which herb may change the effects of hormones in oral contraceptive drugs or patches? saw palmetto Major adverse effects of antihistamines Drying effect, drowsiness, dizziness, dry mouth, change in vision, difficulty urinating, constipation Guafenesin teachings Be careful about drug interactions, avoid alcohol and don't use longer than 1 week Encourage fluid intake. What are the general instructions for using a nasal spray? What is the limitation of using these? Occlude one nostril, shake container, insert tip into other nostril Can't use with deviated septum Aminophylline (theophylline)'s therapeutic response Enhances respiration, heart rate, and heart contractions Increases GFR; to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma Education with taking montelukast Don't smoke, don't use with charcoal cooked foods, caffeine can increase stimulation, don't crush extended release forms, patients learn to take own pulse, watch out for adverse effects & report them immediately Adverse effects of montelukast GI pain, nausea, vomiting, tremors, and headache Assess for suicidal ideation Use of montelukast chronic asthma, seasonal allergic rhinitis, bronchospasm prophylactic --- not used for acute asthma attacks Advair inhaler (fluticasone propionate and salmeterol) instructions read instructions about priming and cleaning, don't get wet or wash, use as instructed, clear nasal passages, don't take extra doses, rinse mouth after use to prevent fungal infections, don't stop abruptly How do you determine when an inhaler needs replacing? divide number of doses by puffs used per day What syndrome is a possible side effect of excessive fluticasone propionate and salmeterol use? (Advair inhaler) Cushing's syndrome = moon face, acne, more fat, swelling What should you report immediately with fluticasone propionate and salmeterol use? (Advair inhaler) rapid weight gain Education with tetracycline Avoid: direct sunlight (use sunscreen), tanning beds, dairy products, antacids, and iron salts should not be used in children younger than 8 years old and should not be used in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium of the teeth (in child or fetus) Why should iron salts be avoided with tetracycline? they reduce its oral absorption Why should tetracycline not be used in children younger than 8? tooth discoloration will occur if the drug binds to the calcium of the teeth What do you monitor with IV antibiotic therapy? Hypersensitivity and anaphylaxis, swelling, tenderness, heat, redness, leaking, and pain Prophylactic use of antibiotics Treatment with antibiotics to prevent an infection; taken before anticipated exposure to an infectious organism ex: intra-abdominal surgery or after trauma Vancomycin (vancocin) use Inhibits cell wall synthesis and treats MRSA, c. diff, and gram positive infections local effects on GI tract, bone, joint, and bloodstream infections. Used with caution in people with renal dysfunction and hearing loss, safe range 5-50 micrograms, can cause ototoxicity and nephrotoxicity, additive neuromuscular blocking effects, can cause red man syndrome: flushing or itching of head, neck, upper trunk, antihistamine may be ordered to reduce these effects. Needs to be infused over 60 minutes. Rapid infusions may cause hypotension. What population must vancomycin be used with caution in? Why? people with renal dysfunction and hearing loss; can cause ototoxicity and nephrotoxicity additive neuromuscular blocking effects, can cause red man syndrome: flushing or itching of head, neck, upper trunk How should vancomycin be infused? Why? Slowly over 60 minutes; rapid infusions may cause hypotension red man syndrome A rash on the upper body caused by vancomycin often caused by being given too quickly Safe trough level of vancomycin Not over 20mcg/mL (dose can be 5-50mcg) What are some of the adverse effects of aminoglycosides? Congenital deafness in children, kidney and ear damage, see urinary casts, proteinuria, and increased BUN and creatinine levels, disrupted sense of balance, dizziness, paresthesia, vertigo, skin rash, fever Adverse effects associated with quinolone antibiotics Bacterial overgrowth in long term use, prolong QT interval, cardiac dysrhythmias (more likely in patients taking antidysrhythmic drugs), tendonitis and tendon rupture, renal failure in older adults, peripheral neuropathy, increased AST and ALT levels, rash, pruritus, flushing, vomiting, diarrhea, blurred vision, chills What is a potential contraindication to antitubercular therapy? Allergy to drug, renal or liver dysfunction, optic neuritis Side effects of Ethambutol (myambutol) use Retrobulbar neuritis, blindness toxic epidermal necrolysis, thrombocytopenia, anaphylaxis Evaluating drug therapy in TB patients Reduction of cough and therefore reduction of the infectiousness of the patient, normally occurs within 2 weeks of the initiation of drug therapy if TB strain is drug sensitive most cases of TB can be cured successful treatment: several antibiotic drugs for at least 6 months and sometimes for as long as 12 months Amphotericin B uses treats systemic fungal infections, treats candida and cryptococcal infections, aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, fungal endocarditis, treatment for severe systemic mycoses Amphotericin B adverse effects fever, cills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea, vomiting, headache acute liver failure, agranulocytosis, necrosis at injection site, toxic epidermal necrolysis Amphotericin B nursing responsibilities assess vitals every 15-30 minutes for first infusion, note blood pressure and pulse changes, intake and output ratio, and decreasing urinary output, give antipyretics, antihistamines, antiemetics, and corticosteroids, give test dose of 1 mg to see if patient will tolerate, look at baseline renal and liver tests, avoid giving other nephrotoxic drugs at same time, assess cardiovascular and GI systems for baseline, watch for bone marrow suppression Is amphotericin B well-tolerated? No - most people have several side effects Almost all patients receiving IV experience fever, chills, hypotension, tachycardia, muscle and joint pain, anorexia, nausea/vomiting, and headache. What can be done to reduce the severity of side effects associated with IV amphotericin B? Pretreatment with antipyretics, antihistamines, antiemetics Often a 1 mg testing dose is given over 20-30 minutes to see if the patient will tolerate the drug Patient teaching with Nystatin (mycostatin) oral lozenges Let dissolve in mouth, don't chew or swallow Use of Nystatin (mycostatin) Applied topically or orally as prophylaxis against candida infections during periods of neutropenia in patients receiving immunosuppressive therapy Also used for treatment of oral and vaginal candidiasis Oral and topical formulations Plaquenil and prophylactic therapy Start taking it before visiting place with malaria Atovaquone (Mepron) class and route antiprotozoal; only orally given Atovaquone (Mepron) is only used when a patient can't tolerate trimethoprim. What adverse effects does it have? Adverse effects are anemia, neutropenia, leukopenia, pruritus, rash, urticaria, anorexia, dizziness, elevated liver enzymes, nausea, constipation, headache, anxiety, fever, hyperkalemia, cough, hyponatremia, and hypoglycemia. What patients should not receive Atovaquone (Mepron)? don't use if patient has severe liver and kidney disease. What is a common side effect of antimalarial drugs? Diarrhea, anorexia, vomiting, dizziness, rash Albuterol trade names Ventolin, Proventil Albuterol uses 1. treatment of ongoing asthma exacerbations 2. prevention of exercise-induced asthma 3. long-term management of asthma Albuterol side effects Tachycardia, heart palpitations, angina, tremors What should a patient report when taking albuterol? Avoid? Report: chest pain, heart palpitations, increased pulse rate Avoid: caffeine Albuterol route respiratory treatment/inhaler Naloxone trade name Narcan Naloxone uses 1. reversal of opioid effects 2. opioid overdose 3. neonatal respiratory depressed Naloxone side effects increased RR, BP, and HR Naloxone routes IM, nasal, IV Benzonatate trade name Tessalon Perles Benzonatate uses antitussive Benzonatate side effects dizziness, headache, nasal congestion, GI upset Benzonatate patient teaching 1. do not chew capsules 2. protect capsules from light and moisture 3. keep out of reach of children (overdose possible) 4. report cough lasting longer than a week Benzonatate route PO (capsules) Scopalamine trade name Transderm-Scop Scopalamine uses n/v, motion sickness placed 4-5 hours before travel preoperative placement to prevent postoperative nausea 1 hour before surgery (removed within 24-36 hours) Scopalamine side effects drowsiness, blurred vision, dry mouth, sedation increases with depressants or alcohol Ondansetron trade name Zofran Ondansetron uses treats chemotherapy and pregnancy induced n/v blocks serotonin Ondansetron side effects bronchospasm, diarrhea, constipation, headache Docusate sodium trade name Colace Docusate sodium uses stool softener, prevent opioid constipation fecal softener, allows water and fats to enter to soften impaction Who should not use docusate sodium? people with intestinal obstruction, fecal impaction, n/v Docusate sodium side effects rash, decreased fat soluble vitamin absorption, lipid pneumonia, electrolyte imbalances Glucagon trade name GlucaGen Glucagon uses increases blood sugar levels to treat hypoglycemia, can be used in radiological exams to look for stomach and intestinal disorders Glucagon side effects anxiety, blurred vision, dizziness, tachycardia, nausea, seizures Glipizide trade name Glucotrol Glipizide uses treats type 2 diabetes by stimulating the pancreas to release insulin Glipizide patient teaching taken 30 minutes before eating very rapid onset of 1 hour and short duration of action of 6-8 hours can be used in patients with renal disease Glipizide side effects hypoglycemia, leukopenia, hepatotoxicity, jaundice, thrombocytopenia, agranulocytosis, aplastic anemia, hemolytic anemia, serious hypersensitivity Pantoprazole trade name Protonix Pantoprazole uses GERD, esophagitis blocks gastric acid secretion Pantoprazole side effects pancreatitis, rhabdomyolysis, pneumonia, stevens-johnson syndrome, toxic epidermal necrolysis, anaphylaxis, angioedema Bisacodyl trade name Dulcolax Bisacodyl uses stimulant laxative works on entire GI tract = used for full bowel evacuation or constipation, used before endoscopy, increases water in colon Bisacodyl route available in rectal and oral forms Bisacodyl side effects nutrient malabsorption, skin rashes, urine discoloration, gastric irritation, electrolyte imbalances, rectal irritation Ketolorac trade name Toradol Ketolorac uses non-opioid analgesic for mild to moderate pain, post-surgical pain, acute pain Ketolorac patient teaching Only use for 5 days (nephrotoxicity and hepatotoxicity) Ketorolac side effects nausea, dyspepsia, intestinal pain, edema, renal impairment, seizures, stroke, heart attack, liver failure, toxic epidermal necrolysis Allopurinol trade name Zyloprim Allopurinol uses anti-gout (prevents uric acid synthesis) Allopurinol adverse effects agranulocytosis, exfoliative dermatitis, toxic epidermal necrolysis, stevens-johnson syndrome, aplastic anemia Isoniazid trade name INH Isoniazid uses drug of choice for TB lasts 24 hours, metabolized in liver