Herbal Heroes
This herb is commonly used to treat mild to moderate depression, but it is a well-known "CYP inducer" that can lower the blood levels of various prescription medications.
What is St. John’s Wort?
A patient taking medication for a seizure disorder is inquiring about the implications of getting pregnant. Why is pregnancy discouraged for patients taking medication for seizure disorders?
Rationale: Antiepileptic drugs must be used cautiously during pregnancy because they are teratogenic.
A patient with acute myeloid leukemia (AML) is receiving filgrastim (Neupogen), a granulocyte colony-stimulating factor (G-CSF). Which of the following findings would the nurse expect to see as a result of this medication?
Increased WBC count (↑ ANC or neutrophils)
A patient is receiving immunosuppressant therapy. Which adverse effects should the patient be educated about regarding these effects?
A. The importance of a high-protein diet
B. The need to maximize fluid intake
C. The need for regular physical activity
D. The importance of personal hygiene and decreasing exposure to germs
D
Personal and hand hygiene will protect from the development of serious infection. The importance of this infection control measure is greater than that of dietary or exercise guidelines.
A patient reports feeling jittery and anxious after using albuterol. What is the nurse's best response?
"This is an expected side effect." It also causes palpitations, tachycardia, hypertension, and hyperglycemia/hypokalemia
Commonly brewed as a tea for its calming effects, this herb is part of the daisy family and should be avoided by individuals with severe ragweed allergies.
What is Chamomile?
What medication may be administered intravenously (IV) to treat status epilepticus seizure activity?
Lorazepam (Ativan), Diazepam (Valium)- Benzos
The pediatric nurse is assessing a child with Wilms tumor who recently completed a chemotherapy regimen that included vincristine. The nurse observes multiple bruises on the child's legs. Which lab test result is most critical for the nurse to review?
Platelets
Why is LMWH used over IV Heparin for DVT prophylaxis?
Because the dose is lower, there are fewer side effects to prevent blood clots, since there is no existing clot. Less adverse effects- HIT and thrombocytopenia
A patient is using both albuterol and fluticasone inhalers. What instruction should the nurse provide about the order of inhaler use? Why?
Use the albuterol inhaler first to bronchodilate and help the other med get to the lungs
Patients scheduled for surgery are often told to stop taking these "G" herbs at least a week prior due to their potential antiplatelet effects and increased bleeding risk. Name two of these G herbs
What are Garlic and Ginger? (Ginkgo and Ginseng also fit this category!)
The nurse administers a selective cholinergic antagonist medication to a patient to dilate their pupil during an eye examination. What would the nurse consider to be a side effect(s)? Select all that apply.
A. dry lips and mouth
B. heart rate 110 bpm
C. voids 50 ml urine, bladder scan notes 400 ml retained urine
D. sudden diarrhea
E. decreased level of consciousness
A, B, C
A patient who has a brain tumor is scheduled to have a port implanted into the ventricle of the brain for intrathecal chemotherapy. The nurse recognizes that the purpose of using intrathecal rather than intravenous chemotherapy is:
A. to prevent bone marrow suppression
B. to avoid gastrointestinal side effects
C. cytotoxic chemotherapy drugs do not readily cross the blood-brain barrier
D. The patient is not as likely to have hair loss
C
A patient is to begin treatment for rheumatoid arthritis with infliximab. What potential risk should the nurse identify as being most commonly associated with this drug?
A. Risk for infection
B. Risk for decreased level of consciousness
C. Risk for nephrotoxicity
D. Risk for hepatotoxicity
A
Rationale: All TNF-alpha blockers carry a risk for infection. This risk supersedes the risks of kidney or liver damage. Changes in LOC are not typically noted.
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled short-acting beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
“I will need to use the beta2-adrenergic agonist drug daily.”
“I should use the glucocorticoid as needed when symptoms flare.”
“The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators.”
What would you teach the patient about using these medications?
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
The short-acting beta2 agonist is a rescue inhaler to use as needed. The inhaled glucocorticoid is for daily use to prevent inflammation.
This root is commonly used to treat insomnia and anxiety; its mechanism is thought to involve increasing the availability of the inhibitory neurotransmitter GABA.
What is Valerian Root?
The nurse has been educating the patient on self-administering phenytoin (Dilantin). Which statement made by the patient demonstrates an understanding of the medication?
A) "I will brush and floss my teeth gently but thoroughly after every meal."
B) "I can stop taking the medication once I have been seizure-free for six months."
C) "If I notice my urine turning a pinkish-red color, I should head to the Emergency Room."
D) "I should take an extra dose if I feel a 'flickering' in my eyes or start feeling uncoordinated."
A) This addresses gingival hyperplasia, a very common and specific side effect of long-term phenytoin use. Folic acid supplements help too.
When giving an oral dose of the cytotoxic drug cycolphosphamide (Cytoxan), the nurse recognizes that which of the following special administration precautions should be observed? The nurse should:
Use gloves to remove the medication from the unit dose package prior to administration, and dispose of the package and medication cup as biohazardous waste.
Often called "clot busters," this class of drugs works by converting plasminogen to plasmin, which then degrades fibrin strands.
What are Fibrinolytics (or Thrombolytics)?
A COPD patient comes to the emergency department with a respiratory rate of 28, a prolonged expiratory phase, tight wheezes, unable to complete full sentences, and has an oxygen saturation of 85% on room air.
The patient reports using a long-acting beta agonist twice daily, an increase from once a day. He ran out of all the "quick " acting medications, so he hasn't used any for 2 days.
The nurse will expect to administer which urgent treatment plan?
Name 3 meds/interventions
1) A DuoNeb-( Albuterol and Atrovent (Ipratropium))
2) Intravenous glucocorticoids- Solumedrol (Methylprednisolone)
3) Oxygen via nasal cannula
Traditionally used to treat menopausal hot flashes, this herb should be used with caution in patients with liver disease or those taking hepatotoxic drugs.
What is Black Cohosh?
The nurse is educating a client diagnosed with Parkinson's disease about the dietary implications of prescribed treatment with levodopa/carbidopa. Which statement by the nurse demonstrated an understanding of the proper administration of this medication?
A. "It's important to take this medication with crackers or applesauce if it makes you nauseous."
B. "Most people find that it's best to take this medication at bedtime, provided you have an empty stomach."
C."If possible, try to eat extra protein when you're taking this medication."
D."Dairy products will make this medication effective, so make sure you take them at the same time."
ANS: A
Rationale: Levodopa/carbidopa is administered with or just after food or following a meal to reduce nausea and vomiting. Levodopa/carbidopa is not administered with a high-protein diet. Dairy products interfere with pharmacokinetics because they are high in protein.
Results of a patient's diagnostic testing reveal inadequate erythropoiesis. Which of the nurse's assessment findings best corroborate this diagnosis?
A. tachycardia and fatigue
B. history of recurrent infections and delayed healing
C. finger clubbing and shortness of breath on exertion
D. delayed clotting and easy bruising
Rationale: Inadequate erythropoiesis results in anemia. Fatigue and an increased heart rate are among the most common and readily apparent signs and symptoms. Anemia does not normally result in respiratory difficulties or finger clubbing. It does not normally result in thrombotic disorders (e.g., easy bruising and delayed clotting) or compromised immune function (e.g., infections and delayed healing).
This is the only muscle relaxant specifically indicated for the emergency treatment of Malignant Hyperthermia, a life-threatening reaction to general anesthesia.
What is Dantrolene?
The nurse knows that theophylline interacts with many medications. Which of the following drugs should be used cautiously with theophylline?
A. Aspirin
B. Warfarin
C. Metformin
D. Lisinopril
Name other medications that it interacts with?
Theophylline and warfarin both have narrow therapeutic windows, meaning that small changes in their levels can have significant effects. Warfarin is an anticoagulant, and theophylline can increase its effects, leading to a higher risk of bleeding. Theophylline can increase warfarin metabolism, necessitating close monitoring of INR and adjustment of the warfarin dose as needed.
Others include- Cimetidine (H2 blocker), Fluoroquinolones (e.g., ciprofloxacin), Macrolide antibiotics (e.g., erythromycin, clarithromycin), Caffeine (excessive intake)
Drugs that may decrease theophylline levels (decreased effectiveness): Phenytoin, Carbamazepine, Rifampin (an antibiotic used in tuberculosis), St. John's Wort (an herbal supplement)