Calculation & Conversion
How many milliliters (mL) are in one ounce (oz)?
30
What are 5 rights of medication administration?
Right patient, Right medication, Right dose, Right route, Right time, Right documentation, Right reason, Right response
List 4 nursing interventions for all clients taking antihypertensive medications.
Assess weight, vital signs, and hydration status. Assess for orthostatic hypotension. Assess baseline labs (e.g. renal, coag). Teach clients to take medication at same time each day. Teach clients to avoid extreme heat (e.g. hot tub, sauna). Teach client to not stop taking the medication abruptly.
What is a LABA? SABA? When should each be used?
LABA - long-acting beta2 adrenergic agonist; long-term control of asthma; e.g. salmeterol
SABA - short-acting beta2 adrenergic agonist; acute bronchospasm; e.g. albuterol
Match the insulin to the onset.
A. Lispro 1. Short-acting
B. Regular 2. Long-acting
C. NPH 3. Rapid-acting
D. Glargine 4. Intermediate
A. Lispro (Humalog) - Rapid-acting. Onset less than 15 minutes. Peak 0.5 to 1 hour. Duration 3 to 4 hours.
B. Regular (Humulin R) - Short-acting. Onset 0.5 to 1 hour. Peak 2 to 3 hours. Duration 5 to 7 hours.
C. NPH (Humulin N) - Intermediate. Onset 1 to 2 hours. Peak 4 to 12 hours. Duration 18 to 24 hours.
D. Glargine (Lantus) - Long-acting. Onset 1 hr. Peak none. Duration 10.5-24 hours.
What are 4 possible reactions to the administration of whole blood and FFP?
Acute hemolytic, febrile, anaphylactic, mild allergic, hypervolemia, sepsis
Other medications should be taken one hour before or after this category of medications.
Antacids.
How many milligrams (mg) are in one grain (gr)?
60
What is the maximum amount of fluid that should be administered in an intramuscular injection for a small infant?
0.5 mL
Match the suffix to the medication category.
A. -dipine 1. Thrombolytic
B. -pril 2. Aminoglycoside
C. -statin 3. Anticoagulant
D. -olol 4. ACE inhibitor
E. -ase 5. Calcium channel blocker
F. -arin 6. Antilipidemic
G. -mycin 7. Beta blocker
A. 5. Calcium channel blocker
B. 4. ACE inhibitor
C. 6. Antilipidemic
D. 7. Beta blocker
E. 1. Thrombolytic
F. 3. Anticoagulant
G. Aminoglycoside
A client is being treated with theophylline for bronchospasm related to bronchitis and asthma exacerbation. The client is being seen at a follow-up visit and complains of heart racing and short periods of black outs. How should the nurse prioritize the care for this patient? Is this a side effect or an adverse reaction? Why?
Complete a thorough history and physical assessment (e.g. VS, cardiac, respiratory, neuro). Obtain a drug level for theophylline (normal is 10-20 mcg/mL). Educate the patient on avoiding caffeine intake.
Side Effects: irritability, restlessness
Toxicity: tachycardia, tachypnea, seizures
What are the correct steps for mixing insulin? Are there any insulins that cannot be mixed?
1. Wash hands, apply gloves (per policy), verify correct insulin, obtain appropriate insulin syringe
2. Wipe the top of each insulin bottle with alcohol
3. Draw up the regular (clear) first
4. Draw up the NPH (cloudy) second
5. Do not mix lispro, glargine, or 70/30 with other insulin
Place the steps for blood administration in the correct order.
A. Verify client ID, name, and blood type with two nurses.
B. Prime IV tubing with normal saline.
C. Establish IV access, 18 gauge or larger.
D. Obtain order for type and cross. Obtain type and cross.
E. Complete infusion within 4 hours.
F. Stay with the client for the first 15 minutes to monitor for any reactions.
1. Obtain order for type and cross. Obtain type and cross.
2. Verify client ID, name, and blood type with two nurses.
3. Establish IV access, 18 gauge or larger.
4. Prime IV tubing with normal saline.
5. Stay with the client for the first 15 minutes to monitor for any reactions.
6. Complete infusion within 4 hours.
Long-term therapy with this category of medications has shown increased risk of gastric cancer and osteoporosis.
Proton Pump Inhibitors (PPIs)
Side/Adverse Effects: Can increase the risk for fractures, pneumonia, and acid rebound
Reference related to fractures and pneumonia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145558/
A patient has a temperature of 100 F. What is their temperature in C?
37.8
C = (F-32)*(5/9)
What is the most appropriate time to draw a trough level?
When the medication is at the lowest concentration which is 15 minutes prior to administration of the next scheduled dose.
ACE Inhibitors and ARBs interrupt the Renin-Angiotensin System (RAS or RAAS = kidney). Calcium Channel Blockers slow calcium movement into cells which produces arterial dilation (decreased BP). Centrally Acting Alpha2 Agonists stimulate the alpha2 receptors in the brain which reduces peripheral vascular resistance (decreased HR and BP). Vasodilators directly affect vasodilation of arteries and veins which creates a rapid reduction in BP due to decreased preload and afterload).
List 5 side/adverse effects of glucocorticoids.
Euphoria, insomnia psychotic behavior; hyperglycemia; peptic ulcer; fluid retention; withdrawal symptoms.
Example Meds: prednisone, prednisolone, betamethasone, beclomethasone diprpionate (QVAR), fluticasone propionate (Advair, Flovent)
Discuss nursing interventions and client education related to the administration of glucagon.
Glucagon should be administered to unconscious diabetic patients or those who cannot swallow due to hypoglycemia.
Steps: Flip the seal off of the vial. Remove the needle cover from the syringe. Insert the needle into the vial and inject the entire contents of the syringe into the vial of Glucagon powder. Reconstitute by gently swirling the vial until contents are mixed. Insert the syringe into the vial and withdraw all liquid. Cleanse the administration site (IM) and administer immediately after reconstituting the Glucagon. Place the patient in recovery position (avoid aspiration). Call 911. May administer a second dose in 15 minutes if patient is not conscious. As soon as the patient is awake and able to swallow, administer a fast-acting source of sugar followed by a snack or meal with protein and carbohydrates. Appropriately discard used supplies and left over Glucagon (if any or if administering 0.5 mL to a pediatric patient).
Provide 3 nursing interventions or items for client teaching related to the oral administration of iron.
1. Dilute liquid preparations with juice or water and administer with a plastic straw or medication dosing syringe to avoid blackening of the teeth.
2. Encourage orange juice fortified with Vitamin C (Vitamin C facilitates absorption).
3. Avoid antacids, coffee, tea, dairy products, or whole grain breads concurrently and for 1 hour after administration due to decreased absorption.
4. Monitor/teach for constipation, GI upset, and black/dark stools.
What is the indication for the use of sucralfate?
Sucralfate (carafate) is a mucosal protectant. It adheres to injured gastric ulcers upon contact wiht gastric acids; provides protective action for up to six hours; has no systemic effects.
Used to treat gastric and duodenal ulcers and GERD. Used in oncology patients.
Client Education: administer on an empty stomach at least 1 hour before meals; do not administer within 30 minutes of antacids.
A patient weighs 180 pounds and has a prescription for 0.5 mL of medication per kilogram of body weight. How many milliliters of medication should the patient receive?
41
180 lbs/2.2 = 81.8 kg = 82 kg
82 kg * 0.5 mL = 41 mL
What are 4 complications that are associated with IV infusions?
Infiltration, Extravasation, Phlebitis/Thrombophlebitis, Hematoma, Venous Spasm
What is a Cardiac Glycoside and how does it work?
Cardiac glycosides are used to treat heart failure or for an ineffective pumping mechanism of the heart muscle.
They have 2 actions. They increase the force and velocity of the myocardial contractions (better stroke volume and cardiac output). They also slow the conduction rate (increased ventricular filling).
This category of medications decreases inflammation, bronchoconstriction, airway edema, and mucus production and is used for long-term management of asthma in adults and children over 15 years of age.
Leukotriene Modifiers
Example Med: montelukast
What are the therapeutic uses of Posterior Pituitary Hormones/Antidiuretic Hormones? What should the nurse monitor?
Action: Promote reabsorption of water with the kidneys; vasoconstriction of vascular smooth muscle
Meds: Desmopressin (DDAVP), Pitressin (Vasopressin)
Uses: diabetes insipidus, cardiac arrest, nocturnal enuresis
Side/Adverse Effects: hyponatremia, seizures, coma
Nursing Interventions: monitor urine specific gravity, blood pressure, and urinary output
What is a therapeutic INR? How long does it take to become therapeutic? Is there a prophylaxis available until a therapeutic INR is obtained? If yes, describe it.
Therapeutic INR = 2.0-3.0
Takes 3-5 days to become therapeutic.
Yes. Patients are often prescribed enoxaparin to take with warfarin until the INR is therapeutic.
What are the side effects of antiemetic medications?
Promethazine: drowsiness, anticholinergic effects, EPS
Metoclopramide: drowsiness, anticholinergic effects, restlessness, EPS, TD
Ondansetron: headache, EPS
Scopolamine: blurred vision, sedation, anticholinergic effects
*What are anticholinergic effects?
A client is receiving D5W at 50 mL/hr in one IV and D5W at 75 mL/hr in another IV. The client also receives IVPB medication every 8 hours prepared in 100 mL of fluid. What is the total amount of IV fluid the client will receive in 8 hours?
1,100 = IV1 + IV2 + IV3
IV 1: 50*8 = 400 mL
IV 2: 75*8 = 600 mL
IV 3: 100 mL
What are 3 complications that are associated with central venous catheters?
Pneumothorax (during insertion), Air Embolism, Lumen Occlusion, Bloodstream Infection
What are the uses and side/adverse effects of adenosine, amiodarone, and atropine?
(Hint: What medication category do they belong in?)
Adenosine: Use - converts SVT to sinus rhythm; Side/Adverse Effects - flushing, nausea, bronchospasm, prolonged asystole
Amiodarone: Use - v-fib, unstable v-tach; Side/Adverse Effects - bradycardia, cardiogenic shock, pulmonary disorders
Atropine: Use - bradycardia; Side/Adverse Effects - none when used for life-threatening emergencies
Match the class to the action.
A. Antitussive
B. Expectorant
C. Mucolytic
1. Enhances the flow of secretions in the respiratory tract
2. Suppresses cough through action in the CNS
3. Promotes increased mucous secretion to increase cough production
A. 2
B. 3
C. 1
What are 4 side/adverse effects of Adrenal Hormone Replacement?
Action: anti-inflammatory suppression of immune response
Side/Adverse Effects: adrenal suppression when administered for inflammation and allergic reactions; infection, hyperglycemia, osteoporosis, GI bleeding, fluid retention
Discuss the differences in the mechanisms of action of anticoagulants, antiplatelets, and thrombolytics.
Anticoagulant: modifies or inhibits clotting factors to prevent clot formation; heparin, enoxaparin, warfarin
Antiplatelet: prevents platelets from aggregating; aspirin, clopidogrel
Thrombolytic: dissolves clots that have already formed; alteplase
The nurse should obtain a complete history and physical assessment including dietary habits. The nurse's priority is electrolyte imbalance to hyperpyrexia (anticholinergic effect related to metoclopramide) and dehydration (loperamide is ineffective).