GI + GU 2
A nurse is about to give a patient psyllium to treat constipation. What are some teaching points to go over with the patient about psyllium as well as other means to prevent constipation? (select all)
A. Take psyllium w/ at least 8 oz of water
B. Lay in bed all day to give this medication time to work
C. Increase your fluid and fiber intake (2-3 L of water daily, increase foods like whole grains, fruits, veggies)
D. Exercise on a daily basis (exercises like walking/running, weight training)
E. Take as much psyllium as you want until you have a bowel movement
A, C, D
Exercise, increasing fluids and fiber, and taking bulk forming laxatives like psyllium with plenty pf water are good teaching points to go over to prevent constipation. Taking too much of a bulk-forming laxative can cause megacolon and can be potentially dangerous if too much is taken.
One of your patients was just prescribed furosemide to treat CHF. What class of medication is this and what is one lab value that must be monitored closely while someone is taking this?
Furosemide (Lasix) is a high ceiling loop diuretic. One lab value that must be monitored closely is potassium because diuretics classically waste potassium.
One of your patients was just prescribed albuterol to treat their asthma. What are some adverse effects that you should warn the patient about? (select all)
A. Lightheadedness
B. Tremors
C. Sedation
D. N/V
E. Tachycardia/angina
B, E
Albuterol is a beta2 adrenergic agonist and so can cause adverse effects like tachycardia/angina and tremors. Other effects can be things like dry mouth, headaches, and insomnia.
This medication is a serotonin antagonist and is used to treat and prevent N/V. Some adverse effects of this medication are headache, diarrhea, dizziness, and a prolonged QT interval.
Ondansetron (Zofran)
This med can be given w/ a few other antiemetics to prevent chemo induced N/V or it can be used for short-term relief of N/V.
You are in the OR and one of your patients is about to be given propofol to induce anesthesia. What are some actions you need to take when using this medication? (select all)
A. Use the opened vial w/ in 6 hours
B. Monitor for anterograde amnesia
C. Monitor for signs of infection
D. Continuously monitor vitals and respiratory effort
E. Monitor for hallucinations afterward
A, C, D
Propofol can cause resp depression, and severe hypotension, so monitoring vitals closely is very important. It can also be a medium for bacteria to grow so monitor for signs of infection and make sure to use/throw away opened vials of propofol w/ in 6 hrs.
One of your patients is taking diphenoxylate plus atropine to treat diarrhea. What are some adverse effects of this medication that should be watched out for? (select all)
A. Dry mouth
B. Headache
C. Euphoria
D. Urine retention
E. Blurred vision
A, C, D, E
Diphenoxylate is an opioid derivative so can cause typical opioid effects (euphoria, CNS depression, resp depression, etc.) at high doses. Atropine is an anticholinergic and so can cause anticholinergic effects (dry mouth, constipation, urine retention, blurred vision).
A nurse is administering a dopamine infusion at a low dose to a patient who has severe heart failure. Which of the following findings is an expected effect of this medication?
A. Lowered heart rate
B. Increased myocardial contractility
C. Decreased conduction through the AV node
D. Vasoconstriction of renal blood vessels
B
The nurse should expect dopamine to cause increased myocardial contractility, which also increases cardiac output. This occurs with the stimulation of beta1 receptors and is a positive inotropic effect of dopamine when it is administered at a low dose.
This medication is an opioid that is widely used to treat chronic, non-productive coughs from things like the common cold.
Codeine
Since it is an opioid, make sure to monitor for common adverse effects of opioids like resp depression, constipation, urine retention, and orthostatic hypotension.
What is losarton used to treat and what are some adverse effects?
Losarton is an ARB and so is used to treat conditions like HTN and CHF. Some adverse effects are orthostatic hypotension, angioedema, and dizziness/lightheadedness.
This medication is a very popular drug to use to treat heart failure and it is a positive inotrope and a negative chronontrope.
Digoxin
Digoxin can also become toxic and signs of toxicity are anorexia, N/V, vision changes, fatigue, abd pain, and dysrhythmias.
This drug is only approved for women who have had IBS with diarrhea with no relief for >6 months and a waiver must be signed due to the chance of GI toxicity, such as ischemic colitis, bowel obstruction, impaction, or perforation and the risk for sudden death.
Alosetron
Other things to consider are it is contraindicated for patients who have chronic constipation, history of bowel obstruction, Crohn’s disease, ulcerative colitis, impaired intestinal circulation, diverticulitis, or thrombophlebitis. Usually takes about 1-4 weeks for symptom relief to occur.
One of your patients was just prescribed hydrochlorothiazide to treat primary HTN. What are some education points to go over with this patient about taking this medication? (select all)
A. Avoid potassium containing foods like bananas
B. Take this medication at night before bed
C. Report muscle weakness, muscle cramps, and or/palpitations
D. Rise slowly if feeling lightheaded
E. You can take this medication, even if you have chronic kidney disease
C, D
Hydrochlorothyazide is a thiazide diuretic and can cause hypokalemia, increased BG, and patients must have working kidneys for this medication to work. You also want to take this medication in the morning to avoid nocturia.
A patient of yours in montelukast to treat their asthma long-term. What should you monitor for as an adverse effect of this medication?
A. Decreased urine output
B. Dizziness
C. Tremors
D. Depressive mood
D.
Montelukast can cause depression and suicidal ideation, so monitor for changes in mood when first giving this medication.
This medication is the prototype calcium channel blocker and what is this medication use to treat?
Nifedipine
This medication is used to treat HTN by blocking calcium channels in the linings of arteries, causing vasodilation and reduced BP.
A nursing is planning care for a patient who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)
A. Assess for tinnitus.
B. Report urine output 50 mL/hr.
C. Monitor serum potassium levels.
D. Elevate the head of bed slowly before ambulation.
E. Recommend eating a banana daily.
A, C, D, E
Furosemide can cause hypokalemia, is ototoxic, and can cause orthostatic hypotension.
A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should anticipate a prescription for which of the following medications?
A. Lubiprostone
B. Metoclopramide
C. Bisacodyl
D. Loperamide
B.
Metoclopramide (Reglan) causes increased upper GI motility and can be used to treat diabetic gastroparesis as well as help treat chemo induced N/V.
This medication is an aplha1, beta1, and beta2 agonist and increases HR, heart contractility, and causes bronchodilation. It is widely used to treat hypotension, cardiac arrest, and anaphalactic reactions.
Epinephrine
Make sure to monitor BP, HR, and patient condition while giving this because it can cause severely high BP and cause dangerous heart arrythmias.
A nurse is teaching a patient who has a new prescription for diphenhydramine for allergic rhinitis. The nurse should instruct the patient to monitor for which of the following adverse reactions of this medication? (Select all that apply.)
A. Dry mouth
B. Nonproductive cough
C. Skin rash
D. Drowsiness
E. Urinary hesitation
A, D, E
Diphenhydramine (Benadryl) is an antihistamine and cause adverse reactions like dry mouth, constipation, urinary retention, dry eyes, and sedation.
A nurse in a provider’s office is monitoring serum electrolytes for four older adult patients who take digoxin. Which of the following electrolyte values increases a patient's risk for digoxin toxicity?
A. Calcium 9.2 mg/dL
B. Calcium 10.3 mg/dL
C. Potassium 3.4 mEq/L
D. Potassium 4.8 mEq/L
C
Low potassium can cause fatal dysrhythmias, especially in older patients who take digoxin. The nurse should notify the provider, who might prescribe a potassium supplement or a potassium-sparing diuretic for the client.
You're working in the OR and one of your patients is going to receive ketamine before the procedure. What should you warn the patient about before giving them this medication?
A. This may cause you to have a severe headache when you wake up.
B. You won't be able to move but you will be able to feel everything. That is why we will give you other medications to make you fall asleep.
C. This may cause nightmares and hallucinations.
D. This will cause you to have amnesia after the procedure.
C
Ketamine can cause severe nightmares and hallucinations after administering it so monitor for manifestations of these.
A nurse is caring for a patient who received prochlorperazine 4 hr ago. The patient reports spasms of his face. The nurse should anticipate a prescription for which of the following medications?
A. Fomepizole
B. Naloxone
C. Phytonadione
D. Diphenhydramine
D.
Prochlorperazine, a dopamine antagonist, which is used to treat N/V can cause EPSs (extra pyramidal symptoms) which include restlessness and spasms of the face and neck. EPSs are treated with antihistamines or anticholinergics and diphenhydramine is an antihistamine.
One of your patients is on captopril to treat HTN. What are some adverse effects of this med? (select all)
A. Hyperkalemia
B. Neutropenia
C. Constipation
D. Cough
E. Orthostatic hypotension
A, B, D, E
Another adverse effect of ACE inhibitors is angioedema. Make sure to moniotr potassium labs, WBC, teach the patient about changing positions slowly, and if they form a chronic cough, switch them to an ARB.
This medication is an inhaled anticholinergic and is used to treat conditions like asthma and COPD. Some adverse effects of this medication are dry mouth and hoarsness.
Ipratropium
Some teachings to go over with the patient are to rinse their mouth out after use, wait the allotted time between puffs from the inhaler, and if they have another medication prescribed to them, wait 5 minutes between taking each.
One of your patients is going on a fishing trip but gets sea sick easily. He is going to use a scopalamine patch to prevent this. What are some things to teach him about using scopalamine? (select all)
A. Apply the patch 4 hr before you leave
B. Change the patch every day
C. Void every 4 hrs while you have the patch on
D. Suck on hard candy, chew gum, or sip water to relieve dry mouth
E. You should be fine to drive the boat while on the trip
A, C, D
Apply the patch 4 hr before leaving, change it every 3 days, rotate sites the patch is on and make sure to clean the previous site. Scopalamine is an anticholinergic so can cause dry mouth, constipation, urine retention, blurred vision, and sedation.
This medication is a beta1 agonist and is used to help treat heart failure short term or to help boost blood pressure in those who are severely hypotensive.
Dobutamine
This medication causes an increase in HR and heart contractility so monitor for things like severe htn, tachycardia, and dysrhythmias.