Terminator 2
Which types of insulin are given based on a sliding scale? Which are given based on a set dose?
Rapid acting
Short acting / regular insulin
Intermediate acting
Long acting
Rapid and short acting (AKA regular insulin) are given based on a sliding scale (amount given is based on the pt's current blood sugar)
Intermediate and long acting are given based on a set dose
How is Lugol's solution used?
Lugol's solution is nonradioactive iodine used for thyroid storm Tx and to establish euthyroid (normal) state prior to surgery for thyroid removal.
A concurrent antihypertensive drug is sometimes given with which medication?
epoetin alfa
ferrous sulfate
methotrexate
filgrastim
epoetin alfa
This medication is given to stimulate the body to generate more RBCs. The sometimes causes HTN d/t the increase in fluid volume from the additional RBCs
You are providing patient education to a newly Dx diabetic during discharge. Who would you ensure is educated on the S/S of hypoglycemia?
Patient, family, and close friends.
Hypoglycemia is life threatening (more dangerous than hyperglycemia) so the patient's loved ones must also be able to tell if the patient is having a hypoglycemic episode and know what to do about it. This could also include teachers if the patient is a child, which would be handled through the school nurse (see the connection between pharm II and comm health!?).
True or false: it is appropriate to massage the injection site after administration of insulin
False.
Massaging the injection site can cause the insulin to be absorbed unevenly. Just leave it be!
Which statement by a patient indicates effective patient teaching about metformin?
I will check by blood sugar often because hypoglycemia is a common problem with this medication
I may have some GI upset with this medication
I must ensure I rotate my injection sites for this medication
I may have some GI upset with this medication
This is a common S/E of this medication, we should teach pt's to take this med with food to deter this. Hypoglycemia is not a common S/E of this medication. This medication is taken PO not by injection, so mention of rotating injection sites would not indicate understanding of the med.
Name three commonalities with most chemotherapy drugs
Generally unsafe during pregnancy (think of how babies grow)
Need antiemetic prior to administration
S/Es; alopecia, mucositis (especially stomatitis/ mouth sores), ulcerations, N/V/D, myelosuppression (bone marrow system suppression, puts pts at risk for infection)
Have to be a chemo trained RN to give these drugs
Which medication is best for metastatic estrogen specific breast cancer?
doxorubicin
tamoxifen
vincristine
filgrastim
tamoxifen
Doxorubicin and vincristine are antineoplastics but not for breast CA. Filgrastim is a colony stimulator for WBC production.
What are two physical hallmark signs of Cushing's Syndrome?
Buffalo hump and moon face
Recall that Cushing syndrome is a result of high levels of corticosteroids in the body over prolonged period. The opposite of this is Addison disease.
What medication is used in the emergency management of hypoglycemia?
Glucagon. Can be given SQ, IM, IV
With administration also remember to turn patient to side afterward to reduce risk of aspiration if vomiting occurs and give 15G of carbs PO as soon as patient is able to SAFELY eat/drink.
What are the two most common routes for cyanocobalamin?
IM and PO
Yes, your test is gonna get cute and call Vitamin B12 by its full name like it's about to get grounded. Try to remember this by thinking vitamin B/blue (cyan is a shade of blue).
Also recall that Vit B12 deficiency is called pernicious anemia and if given IM it's a deep IM injection.
Which medication treats cancer, rheumatoid arthritis, ulcerative colitis, and psoriasis?
Methotrexate
You are administering NPH and lispro insulins. You draw up the NPH first and then the lispro. Is this correct, why or why not?
No, always draw up rapid acting or regular (short acting) insulins first, following the "clear to cloudy" rule to avoid contamination. Since lispro is a rapid acting insulin (and is clear) it should be drawn up first and then the NPH which is intermediate acting.
Also keep in mind that long-acting insulin should not be mixed with other insulins
Which of these medications has a critical adverse effect of nervous system toxicity?
methotrexate
vincristine
doxorubicin
epoetin alfa
Vincristine
Can try to remember this by thinking "Cristine makes me nervous".
This toxicity can look like paresthesia (pins and needles sensation), numbness/tingling, weakness, pain, loss of reflexes.
A client starts taking methimazole. Which finding would indicate that the medication is working?
insomnia
tachycardia
weight gain
Weight gain
Recall with methimazole is used to treat hyperthyroidism and that with hyperthyroidism these pts typically have weight loss. So if the pt starts to gradually gain weight that would indicate normal thyroid function which would mean the medication is working.
Tachycardia and insomnia are S/S of hyperthyroidism, so if the patient still experiences these that would indicate the medication isn't working.
What lab test would be drawn before starting filgrastim?
CBC to get a baseline WBC
Filgrastim is a colony stimulator for promotion of WBC production. We would know the medication is working if there was an increase in WBCs, so we'd need a BL value to compare to.
What potentially life-threatening S/E can metformin cause when mixed with IV contrast?
Lactic acidosis.
This med must be held for 48hrs before and after IV contrast administration to deter renal failure and lactic acidosis (see pg 700 in your book)
Name four pieces of patient education you'd give to someone starting a corticosteroid like hydrocortisone
Take with food to avoid GI upset
Don't abruptly stop; can cause acute adrenal insufficiency / crisis.
Make sure taking Ca and having bone density scans (Long term use of steroids place pts at risk for osteoporosis and therefore fractures)
Advise they will get periodic labs to monitor CBC, lytes, glucose, lipids, liver and kidney function
Report severe leg cramps and muscle weakness (signs of hypokalemia)
Wear medical alert bracelet
Carry a steroid identification card
Report low-grade fevers (100.5) and other signs of infection
Diabetics - check blood sugars more frequently
Desmopressin (DDAVP) is used to treat what?
Diabetes insipidus and nocturnal enuresis
DDAVP is synthetic antidiuretic hormone (the "don't pee" hormone), so if we're giving someone DDAVP we're telling the body to pee less which is what we want for pts with these conditions.
What are four things you would monitor in a patient receiving desmopressin (DDAVP)?
CMP (to check sodium levels), daily weight (same scale, same time of day every day), I&O, neuro status, check for peripheral edema and crackles
This med can cause hyponatremia as well as fluid retention (sometimes even water intoxication which can affect neuro status)
Name three S/E of levothyroxine
Palpitations, chest pain, irregular menstrual cycles, abdominal cramps, diarrhea, vomiting, insomnia, dysrhythmias, weight loss, heat intolerance
What is the indication for octreotide and how does it work?
Is used for the treatment of acromegaly (caused by hypersecretion of growth hormone). Works by inhibiting growth hormone release from the pituitary gland.
What should the nurse assess before giving an SGLT2 inhibitor like dapagliflozin?
Hydration status and BP
Patient's weight
LFTs
Hydration status and BP
This medication promotes renal excretion of glucose through the urine and has a risk of hypotension especially when taken with diuretics. Need to ensure proper hydration to deter hypotension as well as urinary issues with the excess glucose excretion. If BP is soft call provider to determine next steps.
Name three potential symptoms of thyroid storm
High fever (103+), cardiovascular effects (tachycardia, heart failure, angina, MI), and CNS effects (agitation, restlessness, delirium, progressing to coma).
You would get a baseline cardiac evaluation before starting which medication?
doxorubicin
filgrastim
tamoxifen
cyanocobalamin
doxorubicin
Med can be irreversibly cardiotoxic, can be discovered months/years later by pts having HF Sx and/or heart rhythm problems. Can be life threatening.