I HEART YOU
Mr. T is admitted for CHF and 5lbs increase the last 24 hours. which diuretic is most appropiate
1. mannitol
2. furosemide
3. spironolactone
4. milrinone
furosemide: loop diuretic for CHF / fluid overload / pulm edema.
mannitol is for cerebral edema
spironolactone: chf manamgent; potassium sparring
milrinone: inotrope for acute CHF. IV. Monitor for hypotension.
which medication (SATA) would be appropiate
1. IV heparin
2. Heparin SQ
3. Warfarin
4. Dalteparin SQ
5. Enoxaparin SQ
SQ only
1. dalteparin, enoxaparin, heparin
A 53-yr old pt. received abx therapy and 20 minutes into administration, patient's face, scalp, chest, and trunk areas turned flushed and red.
What is this condition called and what antibiotic is most likely culprit and anticipated intervention
red man syndrome
vancomycin
reduce rate
Paul is complaining of white coating on his tongue. he has been on abx for his UTI.
what does he have.
what is anticipated will be ordered
patient education for this medication
thrush
nystatin
swish for 2 min & swallow.
Nancy is a truck driver and complains that she is having trouble with sleepiness during the day.
what medication is appropriate for this patient.
1. Phentermine
2. Methylphenidate
3. Cyclobenzaprine
4. Modafinil
4. modafinil
phentermine: anorexiants, used for obesity (bmi >30 or >27 w/comorbitities)
Cyclobenzaprine: muscle relexants. monitor for sedation/dizziness
Methylphenidate: ADHD. What are some patient education??
which medication is appropriate for hyperthyroidism and some nursing monitoring.
1. levothyroxine
2. PTU
3. propranolol
PTU (propylthioracil)
-monitor for Bone marrow suppression (monitor for fever / infection / bleeding) & Liver toxicity (LFT / jaundice).
propranolol is for thyroid storm due to to much levothyroxine
Mr T has a hx of CHF, AFIB, HTN/HL.
home meds: Furosemide, digoxin, amiodarone, metoprolol, Atorvastatin
1. which medication will increase his risk for digoxin toxicity & why
furosemide.
decrease potassium (hypokalemia) will increase risk for dig toxicity
what is the administration for NTG SL
take 1 at first symptom of CP, if no response call 911 and then take the other two q5 min apart
what are two known antibiotics that have cross sensitivity
penicillin & cephalsporin
nancy was diagnosed with TB and noticed her urine is orange and now she is having some neuropathy.
what medications is she on.
what are some anticipated management for these symptoms.
urine: rifampin. normal. no change.
neuropathy: isoniazid. vit b6
Greg is going out to dinner with his friends but has been started on an MAOI for his depression. what statements indicate further education is needed (SATA)
1. i can have pizza with pepporoni
2. i can have salad with salmon
3. i can have blue cheese with crackers
4. i can have red wine with my meal
5. i can have coffee with my icecream
1, 3, 4
avoid tyramine foods. MAOI prevents metabolism of tyramine which will then cause acute hypertensive crisis in your patient. What s/s would you see if this happened??
soy, aged/process meat, aged cheese, overripe fruit (raisins), red wine, beer, fermented foods
Mrs M. child was admitted with asthma exacerbation.
she was discharged home on fluticasone, albuterol. she is unsure about these medications. what are some patient education with
1. fluticasone
2. albuterol
1. rinse mouth out with water to decrease risk for thrush
2. albuterol is rescue inhaler
3. albuterol first, wait 5 min and then give fluticasone
4. use spacer if child not able to do inhalers properly.
a male patient diagnosed with BPH and HTN and was started on tamsulosin. what patient teaching is important with this patient
first syncope
what two inotrope gtt is commonly used in heart failure patients
dobutamine: monitor for arrhythmias
Milrinone: monitor for hypotension
Mr C was started on ibuprofen, oxycontin for his arthritis.
his labs showed a wbc 10, hgb 9, plts 200.
he also was complaining of dark stools.
which medication are you concerned with and why
what other labs would you want to monitor
ibuprofen
NSAIDS. risk for GIB. contraindicated with GI ulcers.
bun / cr
patient was started on gout medicine but is concerned why he is on colchicine now and instructed he will be on allopurinol later once he is improved.
why.
colchicine: pain relief by reducing inflammation
allopurinol: prevent uric acid production. drink 2L fluid
what medications are indicated for acute seizures (SATA)
1. lorazepam
2. Valproic Acid
3. Carbamazepine
4. Diazepam
1. lorazepam or Diazepam. also for ETOH withdrawal
Valproic Acid: seizure management. monitor LFT
Carbamazepine: seizure management. Autoinduction
patient was started on ciprofloxacin for a UTI. she developed new onset diarrhea.
1. what would your concern be and what would be some tx
2. what are some effects to monitor for
3. what can you do you decrease risk for crystalluria associated with all abx
1. cdiff. check cx. vanco/flagyl PO.
what if cdiff was negative.
2. QTC / tendonitis / rupture
3. increase fluid intake 2l/day
Mrs L was started on atorvastatin for Hyperlipidemia. what are some patient education would you include
1. take with breakfast
2. call provider with muscle weakness/cramps
3. you will need your cholesterol checked in 6-8 weeks.
4. call your provider if you are pregnant
2,3,4
-take at bedtime
-check lft, cpk with muscle weakness/cramps-can lead to rhabdomyolysis.
-cholesterol levels 6-8 weeks
-stop with pregnancy
-take at bedtime.
what adverse effects do you monitor for
1. BB
2. ACE
3. Digoxin
4. Heparin
1. Bronchospasm
2. SE: cough AE: angioedema
3. Dig toxicity (vision-color changes,flashing lights, n/v/diarrhea). increase risk for hypokalemia
4. Bleeding
Mr C 7 yo daughter acne has worsened and needs to be started on ABX. what category is contraindicated for this age group?
why?
what other groups do you want to avoid
any food restrictions
what are some patient education with this category
tetracycline
discolored teeth
pregnant women due to fetal retardation in fetus.
dairy--decreases absorption
sun protection: wide brim hat, long sleeves, sunscreen
robert is in septic shock due to + fungal blood cultures. he was started on amphotericin B.
he developed fever/chills/hypotension with infusion. what should you do at this point.
what are some other nursing implications with amphotericin B
may give antipyretics, antihistamine, steroids to alleviate s/s.
vitals q15 during infusion due to risk for hypotension.
monitor cbc, lft, rfp, ekg
Mr T is being treated for Parkinsons. what is the medication used for his tremors / rigidity and how do you know its working
1. Carbidopa-levodopa
2. benztropine
3. Bupropion
4. Lithium
2. Benztropine: anticholinergic for SLUDGE & tremors / rigidity. patient will be able to perform ADL, write letters
carbidopa-levodopa: used for slowness, gross movement. monitor for orthostatic hypotension
bupropion: used for smoking cessation
Lithium: used for bi-polar. avoid dehydration. 0.6-1.2 levels. monitor for toxicity: vomiting, diarrhea, confusion/tremors.
patient had CABG and was started on Ketorolac.
her recent vitals 80/50, 120
1. what would you be concerned about.
2. what labs would you check.
1. GIB, bleeding due to NSAIDS
2. cbc / bun/cr.
what labs do you monitor for diuretics
BUN / CR
LYTES
what labs do you monitor if applicable for dosing.
what is your reversal agents.
1. heparin
2. warfarin
3. morphine
4. alprazolam
5. acetaminophen
1. aptt----Protamine
2. pt/inr----Vitamin K
3. Naloxone
4. Flumazenil
5. Acetylcysteine
MR C was started on an abx for pseudomonas infection. a week into the treatment, he starts complaining of hearing loss. labs were drawn and revealed wbc-12, hgb-14, plt-190. na-135, k-3.6, cl-100, co2- 26, bun-25, cr 2.1.
what is concerning about this case.
what abx do you anticipate was ordered.
hearing loss & bun/cr. monitor hearing / u/o
gentamycin or another aminoglycoside.
patient was started on erythromycin for his strep infection. he started complaining of generalized itching and angioedema.
what is your concern
what would be some potential treatment
allergic reaction. possible anaphylactic
stop abx
give antihistamine or epi if c/o throat / swallowing / wheezing concerns.
patient is on Phenytoin for seizure management (SATA).
what statement indicates effective teaching
1. stop medication if no further seizures occur
2. i need to see the dentist every 6 months
3. this is used for my neuropathy
4. this can cause gingival hyperplasia
2 & 4: include mouth care
seizure medications should not be stopped abruptly
phenytoin is not used for neuropathy: Gabapentin
your patient was diagnosed with Gout. what medications would you expect to be ordered and why (SATA).
1. colchicine
2. Ribavirin
3. allopurinol
4. Rifampin
1. colchicine: anti-inflammatory, pain, short-term
3. allopurinol: daily, decrease uric acid production. drink fluids
Ribavirin: used for RSV. Preg X. best if given 24-48hours with onset of symptoms
Rifampin: abx for TB infections. what SE do you want to educate your patient on?? whats another medication used for TB and what AE do you want to monitor and what prophylactic would you use.