Know Your Drug Classes
A nurse is reviewing a client’s morning medications. The provider orders amlodipine. Which of the following actions by the nurse is most appropriate before administering this medication?
A. Assess the client's blood glucose level
B. Monitor for signs of bleeding
C. Hold the medication if systolic BP is below 100 mmHg
D. Administer the medication with grapefruit juice
C
Amlodipine is a calcium channel blocker used to manage HTN by relaxing vascular smooth muscle --> vasodilation. If the client’s systolic BP is below 100 mmHg, administering this medication can result in hypotension, dizziness, or even syncope.
REMEMBER: No Grapefruit juice selection on the NCLEX. Continually assess VS before administering antihypertensives.
A nurse needs to administer insulin lispro (Humalog) at 8:00 AM, but the client’s breakfast tray is delayed until 8:30 AM. Which is the most appropriate nursing action?
A. Encourage the client to take a walk while waiting
B. Monitor for hyperglycemia symptoms
C. Administer IV dextrose immediately
D. Ensure food is available before giving insulin lispro
D
Insulin lispro is a rapid-acting insulin that begins lowering blood glucose within 15 minutes of administration. Giving it without food available puts the client at high risk for hypoglycemia, which can occur quickly and lead to confusion, seizures, or even coma.
REMEMBER: Know how fast rapid-acting insulin onsets and think about the least invasive action first.
Which is the preferred intramuscular (IM) injection site for a toddler?
A. Ventrogluteal muscle
B. Deltoid muscle
C. Vastus lateralis muscle
D. Dorsogluteal muscle
C
The vastus lateralis (thigh) is the safest and most recommended IM injection site for toddlers (1–3 years old) because it is well-developed and has minimal risk of nerve or vascular injury.
REMEMBER: When giving IM injections to infants and toddlers, always choose the vastus lateralis unless otherwise specified. The dorsogluteal site is avoided in all ages due to the risk of sciatic nerve damage.
A child weighs 15 kg. The provider orders amoxicillin 20 mg/kg/day in two divided doses. What is the total single dose the child should receive?
What is 150mg/dose?
A client taking statins reports new onset muscle pain. What should the nurse teach the client to do, and why?
What is to report the muscle pain immediately, because it may indicate rhabdomyolysis, a serious adverse effect?
A serious complication of this cholesterol-lowering drug class includes muscle pain and dark-colored urine.
What are statins?
A nurse prepares to administer gentamicin. What drug class is this drug, and which two labs must be reviewed before administration, and why?
What is an aminoglycoside, and we should monitor creatinine and BUN levels due to gentamicin being nephrotoxic?
What is 10ml?
A client weighing 88 lbs is prescribed enoxaparin 1 mg/kg subcutaneously every 12 hours. The pharmacy sends prefilled syringes labeled 100 mg/mL.
What volume (in mL) should the nurse administer per dose?
What is 0.4ml/dose?
A client newly prescribed levothyroxine asks when to take the medication. What is the nurse’s best teaching?
What is to take it first thing in the morning on an empty stomach, at least 30–60 minutes before eating?
Clients taking this class of medication should avoid herbal supplements like ginkgo biloba due to an increased risk of bleeding.
What are anticoagulants?
The nurse is about to administer heparin to a client who has an upcoming epidural procedure. What is the most appropriate action and why?
What is to hold the heparin and notify the provider because heparin increases the risk for spinal hematoma (decreased coagulation)?
A client is receiving IV potassium chloride. What two critical safety practices must the nurse follow during administration?
What are 1) Never give potassium via IV push and 2) Always dilute and infuse potassium slowly using a pump to avoid fatal arrhythmias.
A nurse is administering 1,000 mL of 0.9% NaCl over 10 hours using gravity IV tubing with a drop factor of 10 gtt/mL. What is the drop rate in gtt/min?
What is 17 gtt/min? (Remember you can't have half a drop)
A client is prescribed two different types of eye drops to be administered at the same time each day. What is the correct teaching about how to space the medications?
What is to wait at least 5 minutes between different eye medications to prevent one from washing the other out and ensure proper absorption?
This mood stabilizer requires caution when used with loop diuretics due to the risk of toxicity from sodium depletion.
What is lithium?
A client receiving IV Vancomycin begins to itch, reports flushing, and has a red rash on the neck and chest. What complication is occurring and what is your intervention?
What is Red Man Syndrome, and how we should slow down the infusion because it is a rapid-infusion reaction?
What is the proper flush protocol when someone has a continuous enteral tube feeding and has scheduled medications that need to be administered via the tube?
What is 1) Pause the feeding, 2) Flush with 15-30ml NS, 3) Flush with 10ml NS in between meds, 4) Final flush with 15-30ml NS.
A provider orders 1,000 mL of normal saline to infuse over 8 hours. The IV tubing has a drop factor of 15 gtt/mL. The nurse is administering the fluid by gravity drip. What is the drop rate in gtt/min?
What is 31 gtt/min? (Remember you can't have half a drop)
A diabetic client is prescribed prednisone for a short-term inflammatory condition. What teaching should the nurse provide regarding this new prescription?
What is that corticosteroids like prednisone can increase blood glucose levels, and the client may need closer glucose monitoring or insulin adjustment during therapy?
Name two non-selective beta blockers and explain why they're contraindicated in asthma.
What are Propranolol and Timolol (Or Nadolol, Pindolol, Sotalol)? They are contraindicated in asthma due to blocking beta-2 receptors, causing bronchoconstriction, leading to an asthma attack.
A client is receiving a patient-controlled analgesia (PCA) pump with morphine. The UAP reports the client is difficult to arouse and is breathing slowly. List two priority actions (in order), which medication should be prepared, and two follow-up assessments that must be documented after administration.
What is 1) Stop the PCA THEN assess the client, 2) Prepare to administer naloxone, 3) Document respiratory rate and level of consciousness?
A nurse is caring for a client receiving TPN via a central line. The next TPN bag is delayed from the pharmacy. What complication needs to be prevented, and how can the nurse do that?
What is preventing hypoglycemia due to abrupt discontinuation of TPN by hanging D10W (10% dextrose in water)?
A provider orders dopamine 5 mcg/kg/min for a client weighing 60 kg. The bag is labeled 400 mg dopamine in 250 mL D5W. At what rate in mL/hr should the nurse set the IV pump?
What is 11.25mL/hr?
A client is prescribed Oxybutynin. What are three key side effects the nurse should teach the client to expect, and what safety precautions should be included in the teaching?
What are: 1) Dry mouth, 2) Constipation, 3) Urinary retention, and to include staying hydrated, increasing fiber intake, and reporting difficulty urinating.