On a scale from 1 to 10...
A 56-year-old patient with COPD arrives at the Emergency Room after a suspected Opioid overdose. What is our primary concern at this moment?
Respiratory Depression!
After the administration of Inhalation Anesthetics, the patient has tachycardia, elevated temperature, mottling, body rigidity, and sweating. What is the appropriate first action as the nurse?
Administer IV dantrolene sodium
A pregnant woman is in need of medication for her epileptic disorder during the next nine months. Which of the following medications is the least safe anti-epileptic drug during pregnancy?
Valproic acid (Depakote)
A patient is started on a new antidepressant. What is the priority assessment during the one week follow-up for this patient?
A patient asks you, their nurse, what the function of Carbidopa is in Levodopa-Carbidopa (Sinemet), the drug they take for Parkinson’s Disease. What is a correct response?
“It prevents the breakdown of levodopa before it reaches the blood-brain barrier.”
The patient was found to have taken their home prescription of Hydrocodone (Vicodin). What signs and symptoms are noted as adverse effects of this opioid agonist?
Once a dose of Bupivacaine was injected, the patient reports immediate confusion, tinnitus, numbness, tachycardia, hypotension, and ventricular arrhythmias. What is the most appropriate action as the nurse?
Ensure a patent airway
A patient taking Phenobarbital (Luminal) reports blistering, peeling, flu-like symptoms, joint pain, and a headache. What is the priority/first nursing action?
stop causative agent!
A patient is newly diagnosed with depression. What medication class do you anticipate being prescribed first?
SSRIs (prams or lams!)
A patient is taking Pyridostigmine (Mestinon) for Myasthenia Gravis. After altering their dose, the patient arrives at the Emergency Room with excessive sweating, tears, urination, vomiting, and diarrhea. What is the priority nursing action?
Administer Atropine Sulfate
In the Emergency Department, a 26-year-old was brought in due to difficulty arousing, slow and shallow breathing, and cyanosis of the lips. When looking at their body, you see track marks on the arms. What is the priority action as the nurse?
Give Naloxone (Narcan) IV
After receiving Benzocaine (Hurricane), a patient begins to complain of headache, dizziness, dyspnea and poor muscle coordination. When looking at the patient, there is a bluish-tinge around the lips and extremities. What is the reaction known as?
Methemoglobinemia
What is an important nursing consideration for Phenobarbital (Luminal)?
1. Takes three weeks to reach serum goal level
2. Schedule IV Controlled Substance
3. Half life of 53-118 hours
After starting Duloxetine (Cymbalta), a patient is brought into the hospital with confusion, increased heart rate, muscle twitching, dry mouth, and dilated pupils. What reaction is occurring?
Serotonin Syndrome
A patient is admitted to the hospital with tremors, agitation, diaphoresis, tachycardia, and hallucinations. It is found, through examination of the chart, that the patient has alcohol use disorder and seems to be in the beginning stages of withdrawal. Which category of medications would you anticipate to be prescribed?
Benzodiazepines!
A patient is in an outpatient surgical setting for a procedure. What opiate medication do you anticipate to be combined with Midazolam (Versed) for moderate sedation?
Fentanyl
A patient is preparing to undergo surgery. What aspects in their medical records would contraindicate the use of inhalation anesthetics, such as Isoflurane (Forane)?
2. severe PONV
3. Hepatic dysfunction
A patient with a prescription for Phenytoin (Dilatin) for tonic-clonic seizures arrives at the emergency room with confusion, nausea, drowsiness, unsteadiness, and slurred speech. What serum Phenytoin level matches the signs and symptoms?
25 mcg/mL (or anything >20 mcg/mL)
After a patient has been taking Fluoxetine (Prozac) for a few weeks, they develop rapid blinking, repetitive chewing, lip-smacking, and puffing out cheeks. What is this reaction known as?
Tardive Dyskinesia
A patient is newly diagnosed with Schizophrenia and the physician was talking about starting the patient on Chlorpromazine. What condition in the patient's chart would the nurse determine contraindicates use of this drug?
Glaucoma!
With a fellow nursing student, you enter a patient's room to provide education on their medication, Ketorolac (Toradol). What statement made by the fellow nursing student would you need to correct?
“This medication is a powerful analgesic that has pain relief equivalent to Morphine.”
“Since this is an opioid analgesic, there is a risk of misuse or tolerance development.”
“We will monitor for any GI bleeding or blood in the stool.”
“This medication can be used only for short-term treatment of pain.”
2. “Since this is an opioid analgesic, there is a risk of misuse or tolerance development.”
What are the indications for use of Neuromuscular Blocking Agents, such as Vecuronium, with anesthetics? (hint: there are two)
1. Complete paralysis of skeletal muscles
2. Tracheal intubation or Mechanical ventilation
What is important to monitor for patients on Lacosamide (Vimpat)?
Sudden personality changes or signs of aggression
The patient was prescribed Alprazolam (Xanax) for acute anxiety attacks. They forgot that they took the medication just one hour before and accidentally doubled their dose of the medication. Now, they are difficult to arouse, have decreased respirations, and are bradycardic. What is the priority nursing action?
Administer Flumazenil (Romazicon)
A patient, when taking their medication history, notes they have been taking Zolpidem (Ambien) for the last 6 months to help with sleep. What is important to educate the patient on?
“You should not take this medication long-term as it can develop dependence.”