Drug to Drug Relationships
A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss ____ the ____ dose.
reducing; warfarin
A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?
Reassure the patient that these are expected side effects.
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
A patient has been taking levothyroxine for several years and reports that “for the past 2 weeks, the drug doesn’t seem to work as well as before.” What will the nurse do?
Ask the patient when the prescription was last refilled.
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?
Ask whether the patient is rinsing the mouth after each dose.
A patient is admitted to the hospital and will begin taking levothyroxine [Synthroid]. The nurse learns that the patient also takes warfarin [Coumadin]. The nurse will notify the provider to discuss ____ the ____ dose.
reducing; warfarin
A nurse is providing education to a patient who will begin taking alendronate [Fosamax]. Which complication should the patient be instructed to report immediately?
Difficulty swallowing
A nurse provides teaching for a woman who will begin taking supplemental calcium. Which statement by the woman indicates understanding of the teaching?
“I should not take more than 600 mg of calcium at one time.”
A patient who has been taking 25 mg of hydrocortisone each morning for several months reports feeling fatigued late in the day each day. What will the nurse tell the patient to discuss with the provider?
Splitting the daily dose into a morning and an afternoon dose.
A nursing student, who is preparing to care for a postoperative patient with deep vein thrombosis, asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?
“The onset of warfarin is delayed.”
A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it:
lowers the dose of amphotericin B and reduces toxicity.
A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?
“Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones.”
A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg 3 times a day. What will the nurse include when teaching this patient about this drug?
“You may experience blurred vision, dry mouth, or constipation
A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to:
continue taking the clopidogrel and speak to the provider immediately.
A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially?
Isoniazid, rifampin, pyrazinamide, and ethambutol
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?
Proton pump inhibitors
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?
Red-orange–tinged urine
A nurse is teaching a patient who will begin taking methimazole [Tapazole] for Graves’ disease about the medication. Which statement by the patient indicates understanding of the teaching?
“I should report a sore throat or fever to my provider if either occurs.”
A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats/min. The patient’s most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for:
protamine sulfate.
A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient’s medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do?
Question the patient about how much albuterol has been used.
A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do?
Request an order to administer dexamethasone with the ondansetron.
A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug?
Dantrolene
A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?
“You will take both drugs initially and then stop taking the colchicine.”
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?
Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen.
A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____.
pulmonary embolism; heparin