Neuro (ICP / TBI / SCI)
A patient with severe TBI begins receiving a continuous infusion to reduce cerebral edema. Over the next few hours, the nurse notes increased urine output and rising serum osmolality. Which medication is the nurse most likely administering?
Mannitol
A patient in status epilepticus is given a rapid IV push medication to immediately stop seizure activity. Within minutes, the patient becomes very drowsy with decreased respirations. Which medication was most likely given?
Lorazepam
A patient with hepatic encephalopathy is prescribed a medication that results in 3 loose stools during the shift. A new nurse questions whether the medication should be held due to diarrhea. Which medication is this?
Lactulose
A patient receiving chemotherapy reports severe nausea. The nurse administers a medication that blocks serotonin receptors. Later, the provider orders an EKG. Which medication was given?
Ondansetron
A patient receiving opioid pain medication for pancreatitis becomes increasingly drowsy with a respiratory rate of 10. Which medication is most likely responsible?
Morphine (or hydromorphone/fentanyl – opioid class)
A patient with a cervical spinal cord injury develops hypotension and bradycardia. The provider prescribes a medication to increase heart rate. Which medication is most appropriate?
Atropine
A patient is started on a maintenance anticonvulsant after a seizure. Over time, the nurse notices the patient has swollen, bleeding gums. Which medication is most likely responsible?
Phenytoin
A patient with cirrhosis and ascites is prescribed a diuretic that helps remove fluid while conserving potassium. The nurse notes the potassium level is increasing. Which medication is this?
Spironolactone
A patient receiving chemotherapy develops severe bone pain after starting a medication used to increase white blood cell production. Which medication is most likely responsible?
Filgrastim
A patient with hypertension and liver disease is started on a medication that lowers blood pressure but later develops a persistent dry cough. Which medication is this?
Lisinopril
A patient with increased ICP becomes agitated and restless. The provider orders a medication to decrease cerebral metabolic demand and reduce stimulation. Which medication is most appropriate?
Propofol
A patient with a new seizure disorder is prescribed a medication commonly used because it has fewer drug interactions and does not require routine level monitoring. The patient later reports mood changes and irritability. Which medication is this?
Levetiracetam (Keppra)
A patient with cirrhosis is prescribed an additional diuretic to work with spironolactone. The nurse notes the potassium level is now dropping. Which medication is most likely responsible?
Furosemide (Lasix)
A patient receiving chemotherapy begins to experience numbness and tingling in the hands and feet along with constipation. Which medication is most likely causing these symptoms?
Vincristine
A patient receiving chemotherapy develops painful mouth sores and severe diarrhea. The nurse suspects toxicity from a medication that interferes with DNA synthesis. Which medication is most likely responsible?
5-Fluorouracil (5-FU)
A patient with TBI is given a medication to prevent seizures during the acute phase. The nurse knows this medication requires monitoring of drug levels and can cause gingival hyperplasia. Which medication is this?
Phenytoin
A patient presents with an acute ischemic stroke and is within the treatment window. The provider orders a thrombolytic. Shortly after administration, the patient develops a sudden headache and decreased LOC. What medication was given, and what is the complication?
Alteplase (tPA) → complication = hemorrhage
A patient with chronic pancreatitis is prescribed a medication to improve digestion and reduce steatorrhea. The nurse reinforces that this medication must be taken with meals. Which medication is this?
Pancrelipase
A patient receiving chemotherapy develops new shortness of breath and fatigue. The provider becomes concerned about cardiotoxicity and orders an echocardiogram. Which medication is most likely responsible?
Doxorubicin
A patient with chronic infection is prescribed a medication that inhibits viral DNA replication. The nurse monitors kidney function closely due to risk of nephrotoxicity. Which medication is this?
Tenofovir (NRTI)
A patient with severe TBI has worsening ICP despite initial treatment. The provider orders a hypertonic solution to rapidly reduce cerebral swelling. Which intervention/medication is being used?
Hypertonic saline (e.g., 3% saline)
A patient with an acute stroke has severely elevated blood pressure and is started on a medication to lower BP without drastically reducing cerebral perfusion. The nurse notes the patient’s heart rate begins to decrease. Which medication is this?
Labetalol
A patient with esophageal varices due to cirrhosis is started on a medication to reduce portal pressure and decrease the risk of bleeding. Shortly after administration, the nurse notes the patient’s heart rate has decreased. Which medication is this?
Octreotide
A patient receiving chemotherapy has rising creatinine levels despite adequate hydration. The provider suspects a medication known for nephrotoxicity and ototoxicity. Which medication is this?
Cisplatin
A patient with severe diarrhea is prescribed a medication to slow intestinal motility. The nurse notices the patient has not had a bowel movement in 2 days and now has abdominal distention. Which medication is this, and what is the concern?
Loperamide → concern for constipation/possible obstruction