I HEART YOU
Mr. T is admitted for CHF and 5lbs increase the last 24 hours. which diuretic is most appropriate
1. mannitol
2. furosemide
3. spironolactone
4. milrinone
furosemide: loop diuretic for CHF / fluid overload / pulm edema. monitor for hypokalemia
mannitol is for cerebral edema. monitor LOC/neuro
spironolactone: chf manamgent. monitor for hyperkalemia
milrinone: inotrope for acute CHF. IV. Monitor for ventricular dysrhythmias / elevated LFT.
Mr V is s/p hip surgery and needs DVT prophylaxis.
which medication (SATA) would be appropriate
1. IV heparin
2. Heparin SQ
3. Warfarin PO
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. also used for narcolepsy
phentermine: anorexiants, used for obesity (bmi >30 or >27 w/comorbitities). avoid caffeine since stimulant
Cyclobenzaprine: muscle relaxants. monitor for sedation/dizziness
Methylphenidate: ADHD. What is a dietary restriction.
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: due to leukopenia & bleeding: due to thrombocytopenia) & Liver toxicity (LFT / jaundice).
propranolol is for thyroid storm due to to much levothyroxine
when passing medications to Mr S who is 80yo, the nurse is aware that the following changes occur as a result to aging. Which statements are true: SATA
1. gastric pH is less acidic
2. Protein albumin binding sites are reduced
3. increase body mass
4. decrease cardiac output resulting in decrease functioning of liver / kidneys
1,2,4
this is why we administer lower doses and increase dosages slowly. monitor closely for increase risk for SE / AE
What are your reversal agents for
1. Heparin
2. Warfarin
3. Acetaminophen
4. Lorazepam
5. Morphine
1. Protamine
2. Vitamin K
3. Acetylcysteine
4. Flumazenil
5. Naloxone
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
also for hypomagnesium- exacerbate s/s of digoxin toxicity
what is the administration for NTG SL
take at first symptom of CP, q5 min apart. call 911 if no CP relief
ACUTE episodes only
Monitor for hypotension. SE: headache
what are two known antibiotics that have cross sensitivity
penicillin & cephalsporin
PCN: safe but increase incident for angioedema
CEPH: surgical prophylaxis.
Nancy was diagnosed with TB and noticed her urine is orange and now she is having some neuropathy.
what medications is she on.
what is another TB medication do anticipate she will be administered and what will you monitor for.
urine: rifampin. normal. no change.
neuropathy: isoniazid. vit b6
monitor for improvement in TB s/s: cough, night sweats, weight gain
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.
Nurse Carey is getting ready to administer 10 units of Lispro this morning. Which finding would question administrating this medication
1. BS 68
2. patient complaining of tachycardia & tremors
3. BS 200
4. Polydipsia
5. diaphoresis
1,2,5
all signs of hypoglycemia.
if awake: administer glucose food items
if unresponsive: glucagon---what else would you do with this administration
Mr. T was started on PTU (propylthioracil) 4 weeks ago, what statements would make you concerned: SATA
1. i have been having a sore throat for the past week
2. i have been gaining weight- 2 lbs the last month
3. my urine has changed color
4. i have been sleeping for 8 hours a night.
1,3
monitor for bone marrow suppression / liver toxicity.
the other symptoms are an improvement of hyperthyroidism
a male patient diagnosed with BPH and HTN and was started on tamsulosin. what patient teaching is important with this patient
1. hold this medication if you have a cough
2. move slowly when you change positions
3. you should avoid eating spinach
4. hold this medication if you develop edema
2. move slowly when you change positions
first syncope = move slowly
Mr T was hanging holiday lights and fell off his ladder. he is complaining of headaches and wants pain medication.
hx: afib, CAD s/p Stent to LAD, MI, HTN, HL
medications: Warfarin, Metoprolol, Lisinopril, Atorvastatin
1. any concerns and what diagnostic testing do you anticipate
2. from these options, which would you anticipate for his headache: acetaminophen or Ibuprofen
he is on anticoagulation and with c/o headache--need to rule out cerebral hemorrhagic ---GET HCT
acetaminophen only. NSAIDS will increase bleed.
monitor for s/s of other bleeding-- WHAT WILL THAT BE
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.
monitor bun / cr
contraindicated: children / pregnancy / peptic & GI ulcers
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 which will take few weeks to see full effects. drink 2L fluid in the meantime to flush out uric acid
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 while on cipro
3. what can you do you decrease risk for crystalluria associated with all abx
1. cdiff with diarrhea. check cx. vanco/flagyl PO. may also use Fidaxomicin. ALL MEDICATIONS NEED TO BE PO.
what if cdiff was negative, WHAT CAN SHE USE.
2. Quinolones: monitor for QTC / tendonitis / rupture
3. increase fluid intake 2l/day
the nurse is providing patient teaching about antihistamine, which information should she include: SATA
1. the patient can chew gum if he experiences dry mouth
2. drowsiness is a frequent SE of antihistamines
3. the patient should avoid drinking alcohol beverages while on these drugs
4. you need to monitor for diarrhea
5. monitor for bruising
1,2,3
monitor for drowsiness, dry mouth. avoid ETOH.
contraindicated with BPH & Glaucoma
Mrs L is 75 yo and wanting something for her heartburn.
Hx: COPD, right hip fracture, osteoporosis, htn/hl, OA
which medication would you not recommend
1. Famotidine
2. omeprazole
3. MOM
4. Calcium containing antacids
OMEPRAZOLE
PPI: increase risk for Osteoporosis. do not use in pts with hx of fx, post menopause. check bone density.
vitamin D / calcium / low weight exercising
take in am before meals.
reduction of acid production
Mrs L was started on atorvastatin for Hyperlipidemia. what are some patient education would you include (SATA)
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. monitor also for hypomagnesium
4. Bleeding. monitor aPTT for dosing 45-70 levels
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
contraindicated: pregnant women due to fetal retardation in fetus.
avoid dairy--decreases absorption
teach about sun protection: wide brim hat, long sleeves, sunscreen
robert is in septic shock due to + fungal blood cultures- mycoses (systemic fungal infection). 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 due to AE: Kidney failure, cardiac, neuro, bone marrow toxicity
**these patients really sick and majority will continue tx despite AE since high mortality with fungal infection
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. will also help with tremors. 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
may take with food to decrease upset GI symptoms.
2. cbc / bun/cr.
the nurse will teach a patient who is taking bismuth subsalicylate to avoid which drug because of possibility of toxicity
1. ASA
2. acetaminophen
3. calcium supplements
4. vitamin D tablets
ASA
increases risk for bleeding. monitor for melena. SE: metallic taste
contraindicated to children
a patient with renal failure wants to take an antacid for "sour stomach" which medication would you recommend for this patient
1. aluminum
2. calcium
3. magnesium
4. sodium bicarb
ALUMINUM
what labs do you monitor for diuretics (SATA)
1. CBC
2. LFT
3. electrolytes
4. RENAL
5. Troponin
BUN / CR--renal
LYTES
**know how each will effect NA / K
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. monitor LFT---Acetylcysteine
MR C was started on Gentamycin 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 category does this abx belong to.
hearing loss, tinnitus & bun/cr. monitor hearing / u/o (oliguria)
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
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 frequently
3. this is used for my neuropathy
4. this can cause gingival hyperplasia
2 & 4: include mouth care (saline, gum, frequent dentist)
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 as in INH or Hepatitis C as PO form. Preg X so if given as INH- do not be in room. 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.
patient is preparing for his second course of chemotherapy and is bein prescribed ondansetron. which action is indicated
1. give 30-60min before chemo
2. give medication when the patient notices nausea
3. give acetaminophen if a headache develops
4. monitor for signs of bleeding
5. monitor for dehydration
6. monitor for signs of prolonged QT
1,3,5,6
always give 30-60 min b/4 chemo to prevent nausea. SE: h/a, diarrhea, prolonged QT
avoid ETOH for potential sedative effects.
Mr. L is admitted with nausea & vomiting. AXR reveals dilated gastric area. GI consult also confirms delayed gastric emptying.
hx: liver failure, AF, HTN/HL
1. what medication do you anticipate will be ordered based on his diagnosis
2. if Mr L becomes lethargic and hard to arrouse and ammonia level is 95, which medication would you anticipate will be ordered.
1. a prokinetic: metoclopramide
used for delayed gastric emptying
2. lactulose: monitor LOC, diarrhea