Pharm Final Ati

Front 1

Adverse effects of Carvidopa/Levodopa

Back 1

(Sinemet-anti Parkinsonian; dopaminergic)

Abnormal movements, psychiatric disorders

•Advise clients of potential side effects and to notify the provider if they occur.

Front 2

Adverse effects of morphine, what are you monitoring for?

Back 2

Respiratory depression

constipation

urinary retention

orthostatic hypertension

cough suppression

sedation

biliary colic

emesis

overdose triad: resp. depression, coma and pinpoint pupils

Front 3

What drug would you administer for an anaphylactic reaction to penicillin?

Back 3

Mild rashes and hives can be treated with diphenhydramine (Benadryl).
Anaphylactic reaction is a life-threatening, treat with epinephrine, bronchodilators, and antihistamines. Provide respiratory support and inform the provider.

Front 4

client education for lovastatin

Back 4

(Lipitor; statin)

advise clients to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice), and notify the provider if symptoms occur.

•advise clients to avoid alcohol.

advise clients to report symptoms of muscle aches, pain, and tenderness.

advise clients to observe for signs and symptoms of peripheral neuropathy, and to notify the provider if symptoms occur

advise clients to limit the amount of grapefruit juice consumed each day. Clients should not drink more than 1 qt a day.

Front 5

If you are taking phenelzine - what foods would you avoid?

Back 5

(MAOI; Nardine)

tyramine-rich foods include aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wine.

Concurrent use with vasopressors (caffeine, phenylethylamine) may result in hypertension.

•advise the client to avoid foods that contain these agents (caffeinated beverages, chocolate, fava beans, ginseng)

Front 6

procedure for wasting narcotic analgesics

Back 6

• Dispose in waste receptacle with 2nd nurse observing

Front 7

hydrocodone adverse effects

Back 7

CNS effects (dizziness, lightheadedness, drowsiness, respiratory depression)-Narcan
GI distress (nausea, vomiting, constipation)-take with food
Potential for abuse-use for short duration

Front 8

clonidine transdermal patch, nursing actions for side effects

Back 8

(Catapres; Centrally acting alpha 2 agonist; HTN)

drowsiness and sedation

•drowsiness will diminish as use of medication continues.

•advise clients to avoid activities that require mental alertness until symptoms subside.

dry mouth

•advise clients to be compliant with medication regimen.

•reassure clients that symptoms usually resolve in 2 to 4 weeks.

•encourage clients to chew gum or suck on hard candy, and to take small amounts of water or ice chips.

rebound hypertension

•advise clients not to discontinue treatment without consulting the provider.

•should be discontinued gradually over the course of 2 to 4 days.

Avoid use of transdermal patch on affected skin in scleroderma and systemic lupus erythematosus (SLE).

Transdermal patches are applied every seven days. Advise clients to apply patch on hairless, intact skin on torso or upper arm.

Front 9

teaching for clients who are newly prescribed estrogen and progesterone

Back 9

r/f endometrial or ovarian cancer
-instruct clients to report persistent vaginal bleeding.
•advise clients to have a yearly pelvic exam.
r/f estrogen dependent breast caner
•encourage regular self-breast examinations and mammograms.
r/f dvt
•encourage clients to avoid all nicotine products.
•Monitor clients for pain, swelling, warmth, or erythema of lower legs

Front 10

education of patients receiving morphine via pca

Back 10

The client is the only person who should push the PCA button to prevent inadvertent overdosing

Front 11

if going to be getting testing for allergies, education for medications not to takewithin 1 month of testing date

Back 11

Instruct clients to avoid taking corticosteroids and antihistamines 5 days prior to the testing

Front 12

triamterene lab values to monitor

Back 12

(Dyrenium; K sparing diuretic)

Monitor potassium level.

initiate cardiac monitoring for serum potassium greater than 5 meq/L

Front 13

epogen administration guidelines

Back 13

(epogen administration guidelines; growth factor)
Administer by subcutaneous injection.
Do not agitate the vial of medication.
Use each vial for one dose and do not put the needle back into the vial when withdrawing the medication.
Do not mix medication with any other medication in syringe.

Front 14

oral acycolvir for genital herpes, patient education

Back 14

(Zovirax; antiviral)

Advise clients to refrain from sexual contact while lesions are present.

Clients with healed herpetic lesions should continue to use condoms to prevent transmission of the virus

Front 15

open angle glaucoma if taking pilocarpin 3% drops, what are you looking forwith systemic cholinergic toxicity

Back 15

hold pressure on puncta and nasolacrimal sac at least 60 seconds after instillation

Instruct patient on correct instillation technique to minimize systemic effects

Instruct patient to report urinary urgency, slow heart rate, and wheezing to provider

Front 16

fentanyl transdermal patch for chronic pain patient teaching

Back 16

The first administration of a transdermal fentanyl patch will take several hours to achieve the desired therapeutic effect. Administer short-acting opioids prior to onset of therapeutic effects and for breakthrough pain.

Front 17

medication interactions for hearing loss for lasix

Back 17

(furosemide)

avoid use with other ototoxic medications, such as gentamicin

Front 18

methylphenidate, side effects to report

Back 18

(Ritalin; CNS stimulant)

insomnia, restlessness

dysrhythmias, chest pain, high blood pressure

psychotic symptoms such as hallucinations, paranoia

Front 19

long term chorticosteroids for inflammatory bowel disease, nursinginterventions

Back 19

use corticosteroids in low doses to minimize adverse effects.

•Monitor blood pressure.

•Reduce systemic dose slowly.

•Monitor electrolytes and glucose.

•this medication may slow healing.

•Advise the client to:

◯take oral dose with food.

◯Avoid discontinuing dose suddenly.

◯Report unexpected increase in weight or other signs of fluid retention.

◯Avoid crowds and other exposures to infectious diseases.

Front 20

warfarin patient education

Back 20

Be prepared to administer vitamin K for warfarin overdose.

●Teach clients to self-monitor PT and INR at home as appropriate.

●Advise clients to record dosage, route, and time of warfarin administration on a daily basis.

-use a soft-bristle toothbrush to prevent gum bleeding

-Advise clients to avoid alcohol and over-the-counter and non-prescription medications to prevent adverse effects and medication interactions, such as risk of bleeding.

-instruct clients to maintain a consistent intake of vitamin k to avoid sudden fluctuations that could affect the action of warfarin

Front 21

clozapine 350 mg/ daily, side effects

Back 21

(anti-psychotic)

Risk for fatal agranulocytosis

◯baseline and weekly monitoring of wbC recommended

◯Notification of the provider of signs of infection (fever, sore throat, mouth lesions) necessary

other adverse effects include:

◯sedation

◯orthostatic hypotension

◯anticholinergic effects

Front 22

iv betamethazone, client 31 weeks gestation with premature labor, patienteducation

Back 22

Betamethasone is a glucocorticoid that is administered IM and requires a 24-hr period to be effective. The therapeutic action is to enhance fetal lung maturity and surfactant production.

Front 23

findings for salicylate (aspirin)

Back 23

salicylism may occur with aspirin (tinnitus, sweating, headache and dizziness, and respiratory alkalosis)

Front 24

iv nitropresside, know drip rates, mc/kg/min; increase .5 to maintain map

Back 24

v/t X gtt=rate

Front 25

elder adult with dehydration and acute renal failure, getting d5.45 NS @ 150ml/hr, what findings would you report to the provider immediately

Back 25

fluid overload!
↓ urine output
Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure
Confusion, muscle weakness
Weight gain, ascites
Dyspnea, orthopnea, crackles
Edema, distended neck veins

Front 26

rheumatoid arthritis and methotrexate, educate patient on what symptoms toreport to the provider

Back 26

(DMARD; Rheumatrex)

fever and/or sore throat (r/f infection)

anorexia, abdominal fullness, and jaundice (r/f hepatic fibrosis)

Front 27

neostigmine, muscarinic response; manifestations look like?

Back 27

(Rx Myasthenia Gravis)

increased gastrointestinal motility, increased GI secretions, bradycardia, and urinary urgency

Front 28

morphine for cancer pain, symptoms to address

Back 28

give around the clock in addition to a non-opioid and adjuvant

Front 29

after administering a pain medication, what is your next action

Back 29

• Monitor/assess pt. pain level on a regular basis

• Notify provider if resp <12 min

Front 30

what does an allergic reaction to cefaclor look like?

Back 30

urticaria, rash, hypotension, and/or dyspnea

Front 31

acetaminophne/hydrocodone prn order, see they are getting q4 what do youdo?

Back 31

(liver toxicity)
acute toxicity that results in liver damage with early symptoms of nausea, vomiting, diarrhea, sweating, and abdominal discomfort progressing to hepatic failure, coma, and death

take acetaminophen as prescribed and not to exceed 4 g/day

Front 32

tetracycline for young adult female

Back 32

decreases the efficacy of oral contraceptives

Use of tetracycline during pregnancy after the fourth month can cause staining of the deciduous teeth, but will not have a permanent effect on permanent teeth. In general, tetracyclines should not be given to women who are pregnant or to young children

Front 33

lab values for continued use of warfarin

Back 33

Depending on therapeutic intent, effectiveness may be evidenced by:

PT 1.5 to 2 times control

INR of 2 to 3 for treatment of acute myocardial infarction, atrial fibrillation, pulmonary embolism, venous thrombosis, and/or tissue heart valves

INR of 3 to 4.5 for mechanical heart valve or recurrent systemic embolism

No development or no further development of venous thrombi

Front 34

levothyroxine, adverse reactions

Back 34

(Synthroid; thyroid hormone)

overmedication can result in signs of hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite, abdominal cramping, heat intolerance, fever, diaphoresis, weight loss, and menstrual irregularities)

Front 35

education about the use of mdi's

Back 35

Remove the cap from the inhaler.■Shake the inhaler five to six times.■Hold the inhaler with the mouthpiece at the bottom.■Hold the inhaler with the thumb near the mouthpiece and the index and middle fingers at the top.■Hold the inhaler approximately 2 to 4 cm (1 to 2 in) away from the front of the mouth.■Take a deep breath and then exhale
Tilt the head back slightly, and press the inhaler. While pressing the inhaler, begin a slow, deep breath that lasts for 3 to 5 seconds to facilitate delivery to the air passages.■Hold the breath for 10 seconds to allow the medication to deposit in the airways.■Take the inhaler out of the mouth and slowly exhale through pursed lips.■Resume normal breathing

wait the length of time directed before administering the second puff.

◯Instruct the child to remove the canister and rinse the inhaler, cap, and spacer once a day with warm running water. Instruct the child to dry the inhaler before using it again.

Front 36

bumetanide for heart failure, patient teaching

Back 36

(Bumex; high ceiling loop diuretic; same class as Lasix)

Advise clients to get up slowly to minimize postural hypotension. If faintness or dizziness occurs, instruct clients to sit or lie down

Teach clients to report significant weight loss, lightheadedness, dizziness, GI distress, and/or general weakness

Encourage clients to consume foods high in potassium, such as avocados and strawberries.

●Instruct clients with diabetes to monitor for elevated blood glucose levels.

●Instruct clients to observe for signs of low magnesium levels such as muscle twitching and tremors

Avoid administering the medication late in the day to prevent nocturia

Front 37

if giving penicillin IM administration guidelines

Back 37

IM injection should be done cautiously to avoid injection into a nerve or an artery

Do not mix penicillin and aminoglycosides (gentamicin, tobramycin, etc.) in the same IV solution

Probenecid may be added to penicillin therapy to prolong action

Front 38

nicotinic transdermal system, patient instructions

Back 38

(Nicotrol)

-Clients should apply a nicotine patch to an area of clean, dry skin each day.

-advise clients to avoid using any nicotine products while the patch is on.

-advise clients to stop using patches and to notify the provider if local skin reactions occur.

-remove the patch prior to mri scan and replace when the scan is completed.

Front 39

DI, patient receiving desmopressin, patient education

Back 39

For an intranasal dose, teach the client to clear nasal passage and sit up-right prior to nasal inhalation.

Instruct the client to monitor weight and notify the provider of a gain > 2lb/24 hr.

Instruct the client to restrict fluids if directed and notify provider of headache or confusion. (r/f water intoxication)

With IV administration, monitor the client’s IV site carefully because extravasation can lead to gangrene

notify the provider of chest pain, tightness, diaphoresis (r/f myocardial ischemia)

Front 40

urinary tract infection, allergic to thiazide diuretic, what medications are contradindicated?

Back 40

Do not administer TMP-sMZ [Trimethoprim-sulfamethoxazole (Bactrim)]to clients who have allergies to Thiazide diuretics [hydrochlorothiazide (HcTZ)]=stevens-Johnson syndrome

Front 41

adverse effects of school age child receiving benadryl

Back 41

excitation, hallucinations, in-coordination and seizures

Front 42

hypertension receiving Aldactone, (k sparing) patient education

Back 42

(spironolactone)

-Teach clients to avoid salt substitutes that contain potassium.

●Teach clients to self-monitor blood pressure.

●Instruct clients to keep a log of blood pressure and weight

Front 43

captopril, patient education

Back 43

(Capoten; ACE)
Instruct clients to take captopril at least 1 hr before meals

Advise clients to notify the provider if cough, rash, dysgeusia (lack of taste), and/or signs of infection occur (r/f neutropenia)

r/f angioedema (swelling of the tongue and oral pharynx)-administer epinephrine

Front 44

patient receiving anti tb meds for past 3 months, side effects and patient education

Back 44

Due to the resistance that is developing against the anti-tb meds, combination therapy of up to four medications at a time is presently recommended

Isoniazid-Advise the client not to drink alcohol because it may increase the risk for hepatotoxicity

Rifampin-Inform the client that urine and other secretions will be orange.
Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately.
Inform the client this medication may interfere with the efficacy of oral contraceptives.

Pyrazinamide-Instruct the client to drink a glass of water with each dose and increase fluids during the day.
Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately.
Advise the client to avoid using alcohol

Ethambutol-Instruct the client to report changes in vision immediately

Front 45

k rider, dosage and rate when not in icu, how to administer

Back 45

Never IV bolus (high risk of cardiac arrest).

The maximum recommended rate is 5 to 10 mEq/hr

Front 46

infliximab, adverse reactions

Back 46

(Remicade; biologic DMARD)
subcutaneous injection-site irritation (redness, swelling, pain, itching)
risk of infection, especially tb-assess for sore throat, etc.
severe skin reactions
heart failure-assess for jvd, crackles, dyspnea
blood dyscrasias-monitor for bleeding

Front 47

total hip, getting enoxaparin , administration guidelines

Back 47

(lovonox; anticoagulant)
subcutaneously every 12 hr for 2 to 8 days

Deep subcutaneous injections should be administered in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate

Apply pressure for 1 to 2 min after the injection. Rotate and record injection sites

Front 48

acute angina, nitro, administration guidelines

Back 48

Instruct the client to stop activity.
The client should take a dose of rapid-acting nitroglycerin immediately.
If pain is unrelieved in 5 min, the client should call 9-1-1 or be driven to an emergency department.
The client can take up to two more doses at 5 min intervals

tablets should be stored in original bottles, and in a cool, dark place.
discard tablets after 24 months unless indicated on the package

Front 49

Tylenol is contraindicated in what diseases?

Back 49

(acetaminophen; anlagesic, anitpyretic)

Use cautiously in clients who consume three or more alcoholic drinks per day and those taking warfarin (interferes with metabolism)

Acute toxicity results in liver damage

Front 50

have cancer, with fentanyl transdermal patch, having breakthough pain, whatdrug would you administer

Back 50

morphine iv (rapid acting)

Front 51

tobramycin, getting it daily, what lab values to monitor

Back 51

(Nebcin; aminoglycoside)
monitor i&o, bun, and creatinine levels (r/f nephrotoxicity)

Front 52

which of these meds is contraindicated with asthma; lasix, gliburide,propranolol, digoxin

Back 52

propranolol; r/f respiratory depression

Front 53

whats the lithium therapeutic range?

Back 53

Maintenance level range is between 0.4 to 1.0 mEq/L

Plasma levels > 1.5 mEq/L can result in toxicity

Front 54

administration guidelines for inactivated influenza administration for an adult

Back 54

•allergy to eggs

Front 55

nitro sublingual patient teaching

Back 55

Instruct the client to stop activity.
The client should take a dose of rapid-acting nitroglycerin immediately.
If pain is unrelieved in 5 min, the client should call 9-1-1 or be driven to an emergency department.
The client can take up to two more doses at 5 min intervals

tablets should be stored in original bottles, and in a cool, dark place.
discard tablets after 24 months unless indicated on the package

Front 56

amantadine patient education

Back 56

(Symmetrel; antiretroviral therapy)
Phlebitis and inflammation at the site of infusion
nephrotoxicity- Increase fluids
GI –N,V,D.
Thrombocytopenia

Front 57

complications of tpn administration

Back 57

●Infection and sepsis are evidenced by a fever or elevated WBC count. Infection can result from contamination of the catheter during insertion, contaminated solution, or a long-term indwelling catheter.
●Metabolic complications include hyperglycemia, hypoglycemia, hyperkalemia, hypophosphatemia, hypocalcemia, hypoalbuminemia, dehydration, and fluid overload (as evidenced by weight gain greater than 1 kg/day and edema).
●Mechanical complications include catheter misplacement, pneumothorax (evidenced by shortness of breath, diminished or absent breath sounds), subclavian artery puncture, catheter embolus, air embolus, thrombosis, obstruction, and bolus infusion

Front 58

repaglinide, patient education

Back 58

(Prandin; meglitinides-oral hypoglycemic)
Instruct clients to eat within 30 min of taking a dose of the medication, 3 times/day

avoid concurrent use of repaglinide and gemfibrozil

Monitor for signs of hypoglycemia.
Instruct clients to self-administer a snack of 15 g of carbohydrate (4 oz orange juice, 2 oz grape juice, 8 oz milk, glucose tablets per manufacturer’s suggestion to equal 15 g)

Front 59

if your patient in svt is getting procainimide, pharmacological action of the drug,what would you expect to see after administration

Back 59

(Pronestyl, Procanbid; antidysrhythmic)
-decrease electrical conduction
•increase automaticity
•decrease rate of repolarization

Front 60

nitro ointment for angina, administration guidelines

Back 60

(Nitro-Bid)
-Remove the prior dose before a new dose is applied. Measure specific dose with applicator paper and spread over 2.5 to 3.5 inches of the paper.
•Apply to a clean, hairless area of the body, and cover with clear plastic wrap.
•Follow same guidelines for site selection as for transdermal patch.
•Avoid touching ointment with the hands.

Front 61

patient with life threatening ventricular arrhythmia, what medication would you give first

Back 61

Amiodarone, lidocaine, and epinephrine

Front 62

pt has leukemia, and getting chemo, why are they taking allopurinol

Back 62

(Zyloprim; agent for hyperuricemia)

therapeutic use-hyperuricemia due to chronic gout or secondary to cancer chemotherapy

Front 63

fondaparinux, administration guidelines

Back 63

(Arixtra; Activated factor X (Xa) inhibitor; anticoagulant)
-No monitoring is required. Therefore, these medications are acceptable for home use
-Provide instruction regarding correct self-administration. Medications may be available in pre-filled syringes.
-For subcutaneous injections, use a 20 to 22 gauge needle to withdraw medication from the vial. Then, change to a small needle (gauge 25 or 26, 1/2 to 5/8 in length).
-Deep subcutaneous injections should be administered in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate.
-Apply pressure for 1 to 2 min after the injection. Rotate and record injection sites.
-Instruct clients to monitor for signs of bleeding such as bruising, gums bleeding, abdominal pain, nose bleeds, coffee-ground emesis, and tarry stools.
-Instruct clients not to take over-the-counter NSAIDs, aspirin, or medications containing salicylates.
-Advise client to use an electric razor for shaving and a soft toothbrush

Front 64

influenza vaccine allergies

Back 64

eggs

Front 65

rheumatiod arthritis, long term prednisone, long term effects

Back 65

(Glucocorticoid)

increased risk of infection (fever and/or sore throat)

osteoporosis

adrenal suppression

Front 66

patient receiving vancomycin, start getting rash and flushed face, what to do?

Back 66

administer slowly over 60 min

Front 67

heart failure, have a dry cough, which of the folloowing medications would you stop: htcz, isosorbide, lisinopril, niphedipine

Back 67

lisinopril

Front 68

Pyridium, expected client outcomes

Back 68

(phenazopyridine; bladder analgesic used to treat UTIs)

short-term relief of UTI manifestations

Front 69

calculate drip rates with drop factors of tubing

Back 69

V/T X GTT=Rate