Test 1 #4
A nurse is providing teaching for a patient who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client be taught to monitor? (Select all that apply.)
A. Stomatitis
B. Insomnia
C. Nausea
D. Rash
E. Increased gout pain
C, D, E
All of these are adverse effects of allopurinol therapy and the patient should be educated on each one.
This drug is used to help treat estrogen-dependent cancers like certain forms of breast cancer.
Tomoxifen
This drug blocks receptors for estrogen and so can help slow or stop the growth of estrogen-dependent cancers.
You are about to give a patient of yours nifedipine. What is the action of this med and what should you check before giving it?
It's a calcium channel blocker and so blocks calcium channels in the smooth muscle of the arteries to cause widespread vasodilation. This reduces BP and BP should be checked before giving this.
This medication is an anti anginal med that lowers the O2 demand of the heart and is used to treat chronic, stable angina. (it is also useful to treat exercise-induced angina)
Ranolazine
One adverse effect to watch out for is QT prolongation so avoid use in those on other meds that cause QT prolongation or if they have prolonged QT syndrome.
One of your patients just received an injection of NPH insulin. When should you check to see when they may be most at risk for hypoglycemia?
A. 6-14 hr later
B. 16-24 hr after
C. 1-5 hr after
D. 3-6 hr after
A.
The onset of NPH insulin (intermediate acting) is 6-14 hr after administration and the peak time is when your patients are most at risk for hypoglycemia.
This AED has the potential to cause blood dyscrasias (leukopenia, thrombocytopenia, anemia) and shifts in electrolyte balance.
Carbamazepine
- Make sure to monitor the patient for signs of infection, bleeding, or anemia (SOB, pale skin, fatigue) and monitor their electrolyte labs.
One of your patients is taking methylprednisolone to treat their asthma long-term. What education points should you make about taking this medication? (select all that apply)
A. You will need to taper the dose over a few days to come off this medication
B. You may experience some weight loss while taking this medication
C. Take this medication with food to avoid stomach upset
D. Avoid those who are sick and any live vaccines while taking this medication
A, C, D
Methylprednisolone is a corticosteroid and can cause GI upset/bleeding, immunosuppression, and patients must taper their doses when they come off of it to avoid adrenal insufficiency.
A nurse is teaching a patient who has a new prescription for dextromethorphan to suppress a cough. The nurse should instruct the patient to monitor for which of the following adverse effects of this medication?
A. Diarrhea
B. Anxiety
C. Sedation
D. Palpitations
C.
dextromethorphan is derived from opioids and so can cause sedation at high doses.
A nurse is caring for a client who requests information on the use of feverfew. Which of the following responses should the nurse make?
A. “It is used to treat skin infections.”
B. “It can decrease the frequency of migraine headaches.”
C. “It can lessen the nasal congestion in the common cold.”
D. “It can relieve nausea of morning sickness during pregnancy.”
B
Feverfew is used to decrease the frequency of migraine headaches, but it has not been proven to relieve an existing migraine headache.
What are some s/s of hypothyroidism and hyperthyroidism?
Hypothyroidism: Cold intolerance, weight gain, fatigue, constipation, bradycardia, etc.
Hyperthyroidism: Heat intolerance, weight loss, increased appetite, diarrhea, tachycardia, etc.
This drug is a nonbezodiazapine used exclusively for insomnia and can cause daytime sleepiness/drowsiness.
Zolpidem
- Educate the patient about allotting at least 8 hours of sleep to reduce the risk of daytime sleepiness.
This drug is an antifungal used to treat systemic fungal infections and has adverse effects of nephrotoxicity, bone marrow suppression, infusion reactions, electrolyte imbalances, and thrombophlebitis.
Amphotericin B
Monitor I/Os and kidney function, for signs of bleeding/bruising, electrolyte labs, pain/inflammation at the injection site, and for fever, chills, rashes, etc. during infusion.
One of your patients is having some N/V and has a prescription for ondansetron. Name one condition that would warrant you holding this medication. (Hint: it's heart related)
Prolonged QT interval
ondansetron can cause QT interval prolongation and so if your patient already has this, it is best to avoid using this medication on them.
This herbal supplement acts as an estrogen substitute and can help treat manifestations of menopause. Some adverse effects are: GI distress, lightheadedness, headache, rash, and weight gain.
Black cohosh
Some teachings for this are: Avoid use during pregnancy, don't take for longer than 6 months, avoid use if you are on an antihypertensive (increases their effects), and can cause hypoglycemia in patients on insulin or other diabetes meds.
What are some s/s of hypercalcemia? (calcium >10.5)
decreased muscle tone/weakness, dysrhythmias, drowsiness, constipation, N/V, abdominal pain, apathy, and depression
This term refers to the time it takes for a drug to be reduced to half of the original amount in the body.
Drug half-life
Some drugs are broken down faster than others and so have shorter half-lives than other drugs.
You are giving one of your patients vancomycin to treat their C. dif infection. What adverse reactions should you monitor for? (select all)
A. Headaches
B. Urinary output of <30 ml/hr
C. Hearing loss
D. rashes, flushing, tahcycardia
E. Jaundice
B, C, D
Vancomycin is a broad spectrum antibiotic that can cause renal damage, is ototoxic, and can cause red man syndrome. Peaks and troughs of this drug will also be checked to avoid these.
One of your patients was just prescribed hydrochlorothiazide to treat primary HTN. What are some education points to go over with this patient about taking this medication? (select all)
A. Avoid potassium containing foods like bananas
B. Take this medication at night before bed
C. Report muscle weakness, muscle cramps, and or/palpitations
D. Rise slowly if feeling lightheaded
E. You can take this medication, even if you have chronic kidney disease
C, D
Hydrochlorothyazide is a thiazide diuretic and can cause hypokalemia, increased BG, and patients must have working kidneys for this medication to work. You also want to take this medication in the morning to avoid nocturia.
This form of nutritional support is for those with working GI tracts but either can't consume enough food on their own or cannot chew and swallow (like in vented patients).
Enteral nutrition
This is given either through an NG or OG tube and is usually for specific patient needs (Ex: extra protein, low carb, high fat, low protein, etc.)
What are some s/s of diabetes insipidus (DI) and what would be given to treat it?
S/S: severe urine output, dehydration, tachycardia, hypotension, hypernatremia (electrolyte imbalances), dry mucus membranes, increased thirst
Treatment: vasopressors (desmopressin, vasopressin), fluid + electrolyte replacement
This adverse reaction to neostigmine causes respiratory depression, hypotension, and can cause death if not treated.
Cholinergic crisis
- Atropine is the antidote to a cholinergic crisis
You have a patient with a UTI and they are receiving ciprofloxacin to treat it. What's one sign of an adverse reaction you should be monitoring for?
A. Headache
B. Pain/tenderness near their ankle
C. Parasthesia
D. Ataxia
B.
Cipro has the adverse effect of potentially causing Achilles tendon rupture and so it should be monitored for.
You're teaching a patient that was just prescribed acetylcysteine to help treat cystic fibrosis. What is one thing you should tell them about this medication?
A. “Expect this medication to suppress your cough.”
B. ”Expect this medication to smell like rotten eggs.”
C. “Expect this medication to cause euphoria.”
D. “Expect this medication to turn your urine orange.”
B.
Acetylcysteine classically smells like rotten eggs and you should warn your patients about this before giving it to them.
What are some good food sources of potassium? (select all)
A. Citrus fruit
B. Pears
C. Beans/lentils
D. Cantaloupe
A, C, D
Other good sources are potatoes, spinach, and dried fruit.
Why is it important to monitor blood glucose closely on a diabetic patient who is on a beta blocker?
Beta blockers can mask the s/s of hypoglycemia so it is important to watch these patients' blood glucose more closely.