NCLEX-RNPHARMACOLOGY&NURSINGSCIENCES

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES,Created by Dare Domico, RN, DSN,Revised by Brenda Rowe,1,Answering Pharmacology Questions,If familiar with the medication, use nursing knowledge to answer,Will identify the generic and the trade name,Form a relationship between medication and medical diagnosis,Determine the,classification,of the medication; will assist with action and side effects,2,Answering Pharmacology Questions,Recognize side effects associated with classification and relate nursing interventions,Learn meds in a classification by commonalities in their names (bronchodialators = “line”).,Use medication name to determine action (Lopressor =lo to lower and presser for pressure),Use calculator on computer,3,What are the -,“pril”,“lol”,4,Answering Pharmacology Questions,Points to Remember,Do not take antacid with medications,Do not crush enteric-coated & sustained release tablets,Capsules should not be opened,The nurse never adjust or change a medication dose or abruptly stop medication,Avoid alcohol and smoking,Question (and hold) medications if the order is unclear, or dose is not a normal one.,5,Answering Pharmacology Questions,Trough level is lowest level of drug plasma concentration; draw prior to dose. Used with drugs that are toxic.,6,Nursing Priority,The nurses responsibility in administering medications is influenced by a) nursing guidelines for safe administration, b) pharmacologic implications of the medication, & aspects of medication administration.,The nurse is legally responsible for the medications administered, even when the medication is administered according to a physicians orders.,7,Practice Question,Orally administered levothyroxine (Synthroid) 50 units daily is prescribed for a client with hypothyroidism. The nurse provides medication instructions to the client and tells the client to take the medication,1. Just after breakfast,2. With a snack at 3 PM,3. In the morning on an empty stomach,4. With food,8,Practice Question,A client is prescribed lisinopril (Zestril) for treatment of hypertension. He asks a nurse about possible adverse effects. The nurse should teach him about which of the following common adverse effects of angiotensin converting enzyme (ACE) inhibitors?,Select all that apply,1. Constipation,2. Dizziness,3. Headache,4. Hyperglycemia,5. Hypotension,6. Impotence,9,Sample question,An adult client with Hodgkins disease who weighs 145 lb is to receive vincristine (Oncovin) 25 mcg/kg IV What is the correct dose in micrograms that the client should receive?,10,1,st,weight from lb to kg,145 lb = 65.8 kg,Multiply weight in kg by number of micrograms desired per kg,1645 mcg,11,Sample question,The nurse is verifying whether to give a medication to a client. What should the nurse check first?,1. Clients name,2. Expiration date of the drug.,3. Route of delivery.,4. Chart to see whether the drug was ordered.,12,Sample question,The nurse admits a patient with a fractured femur from the ER. The patient received morphine 10 mg SQ five hours before. The patient is scheduled for surgery and no further pain orders have been written. The patient is complaining of severe pain and the physician can not be reached. The nurse administers 5 mg morphine SQ and the patient is comfortable within 30 minutes. What is the best interpretation of the nurses action?,13,Sample question,1. The nurse made an appropriate nursing judgment by giving a lesser amount of the drug.,2. The nurse acted correctly because the client was in pain and the doctor could not be contacted.,3. The drug had been previously ordered; therefore the nurses actions were correct.,4. The nurse is legally liable for administering a medication with an order.,14,Generic Name,Brand Name,Therapeutic drug class (Classification),Action on body (therapeutic actions),Indications,Contraindications,Dosage,Adverse effects,Drug-food interaction,Nursing Considerations,Assessment,Implementation,Teaching points,15,Chemotherapeutic Agents,Anti-infective,Antibiotics,Antiviral,Antifungal,Antiprotozoal,Anthelmintic,Antineoplastic,16,Anti-infective,Toxic to infective agent,No effect on human host cells,Immune system activity needed,Adverse effects,Toxic effects on kidney, GI tract, & nervous system.,Hypersensitivity and super infections,17,Antibiotics,Chemicals that inhibit specific bacteria,Major classes of antibiotics (aminoglycosides, cephalosporins, fluoroquinoiones, lincosamides, macrolides, monobactams, penicillins and penicillinase-resistant drugs, sulfonamides, tetracyclines, and the disease-specific antimycobacterials and leprostatic drugs.,18,Aminoglycosides,Mycin drugs,Renal and hepatic toxicity,Avoid with herpes and parkinsonism,Avoid with strong diuretics,19,Cephalosporin,Penicillin like,20,Antineoplastic Agents,Akylating Agents,Antimetabolites,Antineoplastic antibiotics,Mitotic inhibitors,Hormones and hormone modulators,21,Anti-inflamatory,NSAIDS,Antigout,22,Immune Modulators,Immune stimulants,Interferons,Interleukins,T/B cell modulators,Immune suppressants,T/B cell suppressors,Monoclonal antibodies,Vaccines,Bacterial vaccines,Toxoids,Viral vaccines,Immune sera,Antitoxins.Antiveniom,23,Drugs Acting on CNS,Anxiolytic and Hypnotic Agents,Antidepressant Agents,Psychotropic Agents,Antiepileptic Agents,Antiparkinsonism Agents,Muscle Relaxants,Narcotics & Antimigraine Agents,General & local Anesthetic Agents,Neuromuscular Junction Blocking Agents,24,Antiparkinsonism Agents,Anticholinergics,Oppose the effects of acetylcholine at receptor sites to normalize the acetylcholine-dopamine imbalance,Dopaminergics,Increase the effects of dopamine at receptor sites.,25,GI drugs,Antacids,Laxative,H2 histamine antagonist,26,Adrenergic Agents,Alpha and Beta adrenergic agents,Alpha-specific adrenergic agents,Beta specific adrenergic agents,Adrenergic agonists (sympathomimetic),Treat shock,Pupil constriction,Bronchospasm,27,The nurse administer atropine sulfate preoperatively to a client. Preoperative teaching would include which of the following?,“This medication will help you relax.”,“This medication will decrease the risk of postoperative infection.”,“This medication will make you drowsy.”,“This medication will make your mouth feel dry.”,28,The nurse administer phenazopyridine (Pyridium) for treatment of a urinary tract infection. Teaching would include advising the client of which effect of the drug?,Dry mouth,Reddish-orange urine,Excessive diuresis,Urinary frequency,29,Which statement indicates the client understands the discharge teaching about the appropriate use of lorazepam (Ativan) to manage anxiety?,“I can take my medication whenever I feel anxious.”,“It is okay to double my dose when I am really anxious.”,“It is safe to have one glass of wine with the medication.”,“The medication is not for the routine stress of life.”,30,A clients asks why peak and trough levels are being drawn. Which is the best response?,“Drawing these blood samples will prevent side effects.”,“Drawing these blood samples will allow you to reach the correct drug level quickly.”,“Drawing these blood samples allows for adjustment to assure you are receiving correct amount of medication.”,“Drawing these blood samples provide your physician with information regarding the type of medication you should be taking.”,31,You administer digoxin (Lanoxin) 0.25 mg to your elderly client for congestive heart failure. Which of the following indicates the desired effect of digoxin?,Decreased myocardial contraction,Increased urine output,Increased heart rate,Decreased cardiac output,32,The client is taking warfarin sodium (Coumadin). Which of the following statements would indicate the client understands the discharge teaching?,“I should avoid eating green leafy vegetables.”,“I should eat at least one serving of broccoli a day.”,“I should limit my salt intake”.,“I should avoid raw fruits.”,33,A physician order regular insulin 8 units by continuous IV infusion. The IV bag of 100 mL NS has 100 units of regular insulin. The nurse sets the infusion pump at how many mL per hour to deliver 8 units per hour?,1 mL,4 mL,8 mL,10 mL,34,The nurse is monitoring an IV infusion of sodium nitroprusside (Nipride). Fifteen minutes after the infusion is started, the clients blood pressure goes from 190/120 mm Hg to 120/90 mm Hg. What is the priority nursing action?,Recheck the BP and call the physician.,Decrease the infusion rate and recheck BP in 5 minutes.,Stop the medication and keep the IV open with D5W.,Assess the clients tolerance of the current level of BP.,35,The client will begin taking phenytoin (Dilantin) for a seizure disorder. Which statement indicates that client understands the information about this medication?,“I should take my medication before coming to the laboratory to have a blood level drawn.”,“I should monitor for side effects and adjust my medication dose depending on how severe the side effects are.”,“I should try to avoid alcohol, but if Im not able to, I can drink alcohol in moderation.”,“I need to perform good oral hygiene, including flossing and brushing my teeth.”,36,The client is receiving Ringers Lactate. What is the tonicity of the prescribed intravenous solution?,Isotonic,Normotonic,Hypotonic,Hypertonic,37,The nurse is teaching the a newly diagnosed diabetic client to obtain glucagon for emergency home use. When the clients asks why, the nurse explains that the purpose is to treat,Hypoglycemia from insulin overdose,Hyperglycemia from insufficient insulin,Lipoatrophy from insulin injections,Lipohypertrophy from inadequate insulin absorption.,38,The client received 20 units of NPH insulin subcutaneously at 8 a.m. When should the nurse assess the client for a hypoglycemic reaction?,10 AM,11 AM,5 PM,11 PM,39,The client is admitted to emergency room in diabetic ketoacidosis. The physician orders intravenous insulin. Which type of insulin should the nurse plan to prepare?,NPH,Regular,Lente,Ultralente,40,The nurse is administering a dose of isoproterenol hydrochloride (Isuprel) to a client. The nurse monitors for which of the following side effects of this medication?,Increased pulse and blood pressure,Drowsiness,Hyperglycemia,Hypokalmia,41,Nursing Science,Intracellular compartment,Extracellular compartment (interstitial fluid),Third-spacing represents volume loss; unavailable for physiological processes,Edema,generalized - anasarca,Intravascular compartment,42,Types of Solutions,Isotonic,same osmolality as body fluids,increase extracellular fluid,Hypotonic,cause movement of water into cells,Hypertonic,movement of water from cells,Crystalloids,contain electrolytes; used for fluid volume replacement,Colloids,plasma expanders,move fluids from interstitial to vascular,43,Tonicity of IV Fluids,Isotonic,0.9% saline (NS),5% dextrose in water (5%DW),5% dextrose in 0.225% saline (5% D/1/4NS),Lactated ringers solution,Hypotonic,0.45% saline (1/2 NS),Hypertonic,5% dextrose in lactated Ringers,5% dextrose in 0.45 saline (5%D1/2NS),5% dextrose in 0.9% saline (5%D/NS,10% dextrose in water (10%D/W),44,Types of Blood Components,Red blood cells,replace erythrocytes;, H&H in 4-6 hrs,Whole Blood,treat hypovolemia,Platelets,Fresh frozen plasma,clotting factors no platelets,Albumin,25 gm/100ml = 50 ml plasma,Cryoprecipitates,clotting factors,45,Blood Administration,No solution but NS is given with blood product,Medications never added or piggybacked to blood,Infusion should not exceed 4 hours,Check expiration date,Hang within 30 minutes from the lab; never refrigerate on the unit,Check V/S and breath sounds prior to administration, in 15 minutes and every hour thereafter till administration completed.,46,IV Therapy,The smaller the gauge # the larger the diameter of the catheter or needle,Emergency fluid administration or blood needs large bore ( 16, 18, 19 gauge),Drip chambers,Micro 60 drops/ml,Macro 10 20 drops/ml,Filters,47,IV Therapy,Change IV site q 48 72 hrs (agency),Change tubing q 24 -72 hrs (agency),Change fluids q 24 hours,No LR with renal failure,48,Sodium (135 - 145mEq),Hyponatremia,BP & pulse vary with vascular volume,muscle weakness;, DTR,Headache; personality change,nausea; abdominal cramping, sp gr; urine output,Hypernatremia,BP & pulse related to vascular volume,Pulmonary edema,muscle twitches,muscle weakness;, DTR,* altered mental function,49,Potassium (3.5 - 5.1),Hypokalemia,Thready, weak, irregular pulse; orthostatic hypotension; EKG changes,shallow ineffective respirations,confusion, lethargy,motility and bowel sounds,Hyperkalemia,slow, weak, irregular pulse; low BP; EKG changes,Muscle weakness,hyperactive bowel sounds,50,Calcium (8.6 - 10),Hypocalcemia, pulse; hypotension; EKG changes,muscle twitching, cramps, tetany, seizures,parathesias; Positive Trousseaus & Chvosteks sign,hyperactive bowel sounds,Hypercalcemis,pulse; ; bradycardia then arrest; BP; EKG changes,muscle weakness,abdominal distention, constipation,51,Magnesium (1.6 - 2.6),Hypomagnesemia,EKG changes; tachycardia; hypertension,motility & bowel sounds,tetany; seizures,irritability; confusion,Hypermagnesemia,Bradycardia; dysrhythmias; hypotension,muscle weakness,lethargy to coma,52,Phosphate (2.7 - 4.5),Hypophosphatemia,contractility,shallow respirations,muscle weakness,rhabdomyolysis,irritability; confusion; & seizures, platelet aggregation; immunosuppression,Hyperphosphatemia,as seen in hypocalcemia,53,Practice Question,A client is experiencing edema and fluid overload. Which of the following interventions by the nurse will provide the most accurate evaluation of the clients fluid balance?,1. Measurement of intake and output,2. Assessment of thirst and tissue turgor.,3. Evaluation of changes in daily weight.,4. Evaluation of vital signs every 3 hours.,54,Practice Question,Postoperative orders are D,5,1/2 NS with 40 mEq of KCL. The liter of LR solution has not completely infused. What action will the nurse take?,1. Finish the current liter of fluid.,2. Ask the client if he needs to void.,3. Hang the ordered IV.,4. Assess the IV site,55,Practice Question,A nurse is preparing to care for a client with a potassium deficit. The nurse recognized that the client is at risk for potassium deficit because the client,1. requires nasogastric suctioning,2. has a history of renal disease.,3. has a history of Addisons disease.,4. is taking a potassium-sparing diuretic,56,A client is receiving potassium chloride IV, a diuretic, and digoxin. The nurses plan of care would be based on which of the following?,Hyperkalemia will potentiate the action of digoxin.,A potassium-sparing diuretic will not affect the clients potassium level.,Metabolic alkalosis will increase the clients potassium level.,Administration of intravenous potassium chloride should not exceed 10 mEq/hour.,57,The nurse instructs a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse informs the client that hypoglycemia is a blood glucose level of less than,120 mg/dL,110 mg/dL,90 mg/dL,60 mg/dL,58,Normal Blood Gases,pH7.35-7.45,Pco,2,35-45,HCO,2,22-27,Po,2,80-100,In acidosis the pH is down,In alkalosis the pH is up,Respiratory function indicator is Pco,2,Metabolic function indicator is bicarbonate,59,Practice Questions,The nurse reviews the blood gas results of a clients with Guillain-Barre syndrome. The nurse determines that the client is experiencing respiratory acidosis. Which of the following validates the nurses findings?,1. pH 7.50, Pco,2,52 mm Hg.,2. pH 7.35, Pco,2,40 mm Hg,3. pH 7.25, Pco,2,50 mm Hg,4. pH 7.50, Pco,2,30 mm Hg,60,Practice Question,The nurse is reviewing the physicians orders for a new client. The client has just returned from surgery, is NPO, and has a nasogastric tube. Which order would the nurse question?,1. Potassium 20 mEq IV push,2. 1000 mlD5 NS 125 ml/hour.,3. 1000 D5W with 40 mEq potassium 100 ml/hour,4. Cefoxitin (Mefoxin) 1 gm RV in 50 ml D5W over 15 minutes.,61,A client is admitted with a blood glucose of 130 mg/dL, bicarbonate is 27 mEq/L, blood pressure is 148/94, and pulse is 88. The first nursing priority will be?,Give 40 units of regular insulin.,Check urine for sugar and acetone.,Encourage deep, slow breaths.,Record the admitting baseline data.,62,Which client information, documented during an assessment would be a contraindication to the client receiving verapamil (Calan)?,Epigastric pain and treatment for a peptic ulcer.,Hypertension and angina on exertion.,History of asthma and allergic bronchitis.,Hypotension associated with bradycardia.,63,Practice Question,The nurse is providing discharge teaching to a client newly diagnosed with rheumatoid arthritis is being discharged on Prednisone. What information is most important to teach the client?,1. Record daily weight to determine weight gain.,2. Increase dose of medication as needed.,3. Do not discontinue medication abruptly.,4. Increase fluid intake,64,Practice Question,The client had a colon resection with ileostomy this AM, is receiving an IV of NS at 125 ml per hour, and has a nasogastric tube to suction. Which laboratory value would cause the nurse the most concern?,1. Blood urea nitrogen 32 mg/dl,2. Serum glucose 190 mg/dl.,3. Hemoglobin 13.5, hematocrit 41 %,4. Sodium 155 mEq/L,65,Practice Question,A client has returned from the recovery room. He is lethargic but responsive. He has O,2, 4 L via nasal cannula. The initial nursing assessment reveals the O,2,saturation on the pulse oximetry is 82%. What is the priority nursing action?,1. Perform a complete neurological check,2. Increase the O,2,flow and recheck the pulse oximetery.,3. Suction the client and recheck the vital signs.,4. Stimulate the client to cough and deep breathe.,66,Sample Question,The nurse is caring for a 15 year-old client with type 1 diabetes. What values on the arterial blood gases would indicate the client is developing a complication as a result of poorly controlled diabetes?,1. Paco,2,48 mm Hg, pH 7.67, Po,2,98 mm Hg., HCO,3,24 mEq/L,2. Paco,2,33 mm Hg, pH 7.48, Po,2,88 mm Hg., HCO,3,26 mEq/L,3. Paco,2,40 mm Hg, pH 7.45, Po,2,82mm Hg., O,2,sat 90%,4. Paco,2,38 mm Hg, pH 7.31, Po,2,82 mm Hg., HCO,3,18,67,A client is experiencing severe diarrhea. The nurse will closely monitor for which acid-base imbalance?,Respiratory alkalosis,Respiratory acidosis,Metabolic acidosis,Metabolic alkalosis,68,The clients arterial blood gases are pH of 7.30, Pco,2,of 58 mm Hg, Po,2,of 80 mm Hg, and a HCO,3,of 27 mEq/L. The client has which acid-base imbalance?,Metabolic acidosis,Metabolic alkalosis,Respiratory acidosis,Respiratory alkalosis,69,Nutrition,Basic Human Need,Consider clients diagnosis,Restrictions,Requirements,Types of therapeutic diets,Nutrients in foods,Supplemental feedings,Enteral feedings,70,Therapeutic Diets,Clear Liquid,Full liquid,Soft diet,Avoid raw fruits & vegetables, fried foods, nuts, & whole grains,Bland diet,Avoid alcohol, caffeine, fried foods, peper8 spicy foods,Low-residue,High carbohydrate,Avoid raw fruits and vegetables, seeds, plant fiber limit dairy,71,Therapeutic diets,High-residue/high fiber diet,Fat controlled diet,High-calorie diet,Sodium -restricted diet,Protein-restricted diet,High-protein diet,Low-calcium diet,High calcium diet,72,Therapeutic diets,Low-purine diet,High-iron diet,Carbohydrate control diet,Vegetarian diet,73,Enteral Nutrition,GI tract functioning,74,Practi