Adverse Reactions/Safety/Other
What is the most common adverse effect of diphenhydramine?
Drowsiness
You just admitted a patient with a long-standing history of smoking 2 packs of cigarettes per day with cough, fever and shortness of breath. Lung sounds demonstrated inspiratory and expiratory wheezes in all fields. Oxygen saturation is 87%. What is the rationale for why albuterol is prescribed for this patient?
To open the airways and ease breathing. Albuterol is the rescue inhaler.
You are the nurse checking in a patient with dysfunctional uterine bleeding (heavy and irregular periods). What medication do you anticipate the provider will likely prescribe for this condition?
Medroxyprogesterone Acetate
What are the administration placement guidelines for a transdermal estrogen patch?
Apply to clean, dry and intact skin on the trunk or abdomen but NOT on the breast or at the waistline
Weight =33kg.
Calculate the mls to meet the daily IV fluid requirement
33 kg
For the first 10kg give 100mls/kg
For the second 10kg give 50 mls/kg
Anything over 20kg give 20mls /kg
10x100ml =1000mls
10x 50 mls=500mls
13 x20mls=260ml
1000 +500 +260 =1760 ml
You are providing a patient with albuterol via a handheld nebulizer treatment. Which of the following would the nurse recognize as an common adverse drug reaction to albuterol?
Bradycardia
Lethargy
Oral Thrush
Tremors
Tremors
You are teaching a client how to use an inhaler. What are the steps to correct inhaler use?
1. Shake before using and ensure cap is removed
2. Exhale fully
3. Inhale at the same time as pressing down on the inhaler cannister
4. Hold breathe for 10 seconds, then exhale
What medication treats hypogonadism in male patients who are experiencing testicular failure?
Testosterone
A patient has been prescribed diphenhydramine for allergic reactions. What food/beverage should be avoided?
Weight= 7.1 kg. Calculate the daily amount based on the patient's weight and then set up the IV pump and calculate the mls/hr. to meet the IV fluid replacement
Weight is 7.1kg
For the first 10kg give 100mls/kg
For the second 10kg give 50 mls/kg
Anything over 20kg give 20mls /kg
7.1 kg x100mls. =710mls
710 divided by 24 to obtain mls per hour over 24 hours
710 divided by 24=29.58. Round to whole number=30mls/hr.
What client clinical situations (medical conditions) would the nurse question the order to give diphenhydramine?
1. Benign prostatic hypertrophy
2. Urinary retention
3. Narrow Angle Glaucoma
A nurse is providing discharge instructions in the Emergency Room for a patient with bronchitis who has been prescribed guaifenesin. What is are 2 important item to include in the teaching plan?
1. Drink 1500-2000 ml per day
2. Report to the provider if symptoms or if cough lasts for more than 1 week.
3. Take the medication with food if causes GI upset
4. Lie down or sit down if feeling lightheaded
5. Do not take with combination products for colds that also contain guaifenesin.
What medication works by relaxing the smooth muscle of the prostate gland to increase urine flow and decrease BPH symptoms
Tamsulosin
A patient is being started on an inhaled prednisone to manage and control asthma symptoms. What important client teaching should the nurse include?
1. Rinse mouth after using inhalers to prevent oral candidiasis
2. Use the beta 2 agonist inhaler first to dilate the airways before using the glucocorticoid.
Order: Give 5 mL/kg IV bolus over 1 hour
Weight: 12 kg
The nurse will administer _____ mL/hr.
(Round to whole number)
5ml x 12 kg= 60 mL
60ml/hours=60 mL/hr. Round if necessary
A nurse is reviewing the medical records of a 33-year-old patient who is requesting a combination oral contraceptive of ethinyl estradiol and drospirenone. What finding maybe concerning that the nurse should bring to the providers attention if found in the medical record?
History of smoking 1 package of cigarettes per day
A nurse in the orthopedic clinic is calling a patient who wants to schedule elective orthopedic surgery. The nurse notes that the patient is taking conjugated estrogen and medroxyprogesterone acetate to relieve menopausal symptoms. For how long should the nurse advise the patient to stop the medication to reduce thromboembolic events?
4 weeks
A patient has been prescribed bethanechol for neurogenic bladder? That is the therapeutic action of this medication?
Bethanechol is a cholinergic agonist that activates receptors that line the bladder causing the bladder to contract. It also relaxes the internal sphincter of the bladder. Contraction of the bladder with the relaxation of the sphincter allows the patient to urinate more freely.
What are the appropriate nursing assessments that a nurse should include on a client receiving testosterone therapy? (Include at least 2)
1. Monitor Intake and Output
2. Monitor Weight
3. Monitor Sodium Levels
4. Hand and Wrist x-rays for those who are young
Weight: 23 kg
The nurse will first calculate the daily amount based on the patient weight.
Now the nurse prepares to set up the IV pump and calculates the mL/hr to meet the IV fluid replacement.
(Round to whole number)
Formula:
For the first 10kg give 100mls/kg
For the second 10kg give 50 mls/kg
Anything over 20kg give 20mls /kg
10 kg x 100mls =1000mls
10 kg x 50 mls =500 mls
3 kg x 20 mls =60 mls
1000 + 500 + 60 = 1560 mls
Now divide to calculate mLs/ hour
1560 /24 hours = 65 mLs/hr.
You are caring for a client who has a new prescription for oxybutynin for an overactive bladder. What medical history would be pertinent for you to report to the provider as a contraindication to starting the medication?
A history of narrow-angle glaucoma
A client has been prescribed buccal testosterone. What teaching should the nurse include in patient education? Include at least 2 teaching points
1. Apply to gums above the upper incisor
2. Apply pressure with a finger for 30 seconds
3. Alternate sides of the mouth
4. Expect a bitter taste in the mouth
A patient on the medical surgical floor is receiving albuterol and acetylcysteine as part of their therapy for chronic obstructive pulmonary disease. The patient questions the reasons for both medications. The nurse's best response is? (state the reason for both medications)
1. Albuterol will open the bronchi
2. Acetylcysteine will help cough up the mucus
A nurse is providing initial education on a patient who is on a combination oral contraceptive of ethinyl estradiol and drospirenone. What symptoms should the nurse educate the patient on as a priority to report to the healthcare provider and why?
1. Leg pain, erythema and edema as a sign of deep vein thrombosis (DVT).
Weight: 18 kg
Height: 41 cm
The body surface area is _____ meters squared (m²).
(Round to nearest hundredth)
18 =38/3600
738/3600= square root of 0.21=0.45m2
Be sure to divide 738 by 3600, hit equals, then hit square root.