Nurse should observe most closely for drug toxicity when a client
receives med that has what characteristic
Narrow therapeutic index
Nurse is conducting DC teaching about anti-anxiety drug diazepam
(valium)
Evaluate the ingredients of all over-the-counter drugs for alcohol
content
Nursing instruction most important for patient on Zyloprim
Increase fluid intake
Client getting Tofranil (Imipramine)
Give medication at night
Magnesium antidote
Calcium gluconate
Patient with hyperthyroidism taking inderal (propanalol)
Decreases pulse rate
Medication dosing-heparin 25000 units at 7ml/hr doctor changed rate to
900 units what is the
Mls/hr
Med was ordered 100mg in 4 divided doses in 24 hours available in
25mg, how many will you give every 6 hours
1 pill Q6H
Patient on benzos
Answer is not narcan
Patient Dx with bipolar-how to know if meds are effective
Family states patient is doing better with manic phases
Patient on Heparin going for surgery in a.m.,-priority
Assess patient for bleeds
Best time to give patient Abx (I think)
Time was like 1000, 1400, 1200, and 0400…best to give around the
clock
Medication calculation-patient weighs equal to 16kg-order for Tamiflu
45mg BID
Must round up-answer is 3.8ml
Peptic ulcer med-what action
Histamine 2 agonist
Patient on folliculitis medication-what to teach
Drink with full glass of water
Rapid-Lispro (Humalog) and Aspart (Novolog) Onset: 5-15 minutes
Peak: .75-1.5 hours
Short acting- regular (humulin) Onset: 30-60 minutes Peak: 2-3 hours
(IV ok)
Intermediate acting- NPH Onset: 1-2 hours Pea:k 6-12 hours
Long acting- Glargine (lantus) Onset: 1.1 hour Peak: 14-20 hours (DO
NOT MIX)
Chlamidia
Tetracycline
Trichomoniasis
Flagyl
Candidiasis
Nystatin
Herpes Simplex 2
Acyclovir
Parkinson’s disease
Levodopa/Carbidopa
Phenobarbitol
Seizures
Preparing to administer a drug to a pt with an infection
The drug will destroy the microorganism
RN is teaching a pt about a new drug… what’s most important to teach
the pt to improve the intensity of the response to the drug
Take the prescribed dose
A nurse is giving morphine 2 mg IV to a pt after surgery and she has
followed the “six rights of administration”…
Know the possible reactions to morphine
RN doesn’t understand why a pt is to receive a prescribed med
Verity the reason with the prescribing healthcare provider for use
Administration of schedule IV drug, the RN understands
The drug has acceptable medical application with low potential for
abuse
Where would a RN direct a pt to obtain more info about prescribed
medications
A pharmacist
RN is prepared to administer Epinephrine to pt that has a severe allergic
reaction
IV – no first pass effect
Digoxin has 36-48 hr half life – because of the length of half life, the RN
expects to be dosing this medication
Once a day
Pt is prescribed Cimetidine (histamine 2 antagonist) to treat gastric ulcer
Inhibit the action of histamine at receptor sites and block gastric acid
secretion
Drug X has a therapeutic index of 10 and drug Y has an index of 2
Drug Y – more potent
A pt taking Digoxin is also prescribed Propanolol. The 2 drugs
combined may cause a serious decrease in HR
An increased adverse effect
A pt prescribed CCB Diltiazem to treat hypertension
Grapefruit juice
Which of the pts would be at highest risk for an adverse reaction
An 84 yo with diabetes, HF, hypertension and takes 8 medications per
day
RN receives a handwritten medication order – can’t read
Contact prescriber to clarify order
A breast-feeding pt is prescribed an antimicrobial medication
Take immediately after breast-feeding
The RN is evaluating the kidney fx of an 82 yo pt before administration
of medications
Creatinine clearance – a measure of how the kidneys are fx by
excreting creatinine.
The most important factor in an adverse drug reaction in the elderly
population is
Declining renal fx
A pt is prescribed Bethanocol (Muscarinic Agonist) for urinary retention
- if pt exhibits signs of overdose such as: increased salivation, sweating,
bradycardia, hypotention, the RN would administer
Atropine (anticholenergic – makes us dry)
The pt takes Oxybutinin (anticholenergic) for OOB takes an OTC
antihistamine (anticholenergic) for hay fever
Dry mouth, increased temp, and blurry vision (myosis)
After IM injection of penicillin the pt develops severe difficulty
breathing and swollen tongue (Anaphylaxis)
Administer epinephrine
A pt receives Dopamine for shock (hypotention, vascular collapse,
comatose)
Mean arterial pressure
Pt receives a drug that blocks adrenergic receptors
Orthostatic hypotension (no BP to the brain)
Reflex tachacardia is caused by hypotention
A pt with diabetes gets a beta blocker (mask the signs of hypoglycemia
and blocks beta receptors – inhibits glycogenolysis)
Atenolol (more selective)
A pt with depression is prescribed an antidepressant – the medication
will reach full therapeutic effect
2 to 3 weeks (more like 1 to 2 months but this is the best response)
A pt taking Levadopa/Carbadopa (dopaminergic) and experiences a
frequent “on – off” episodes
Avoid high protein meals – competes with drug
A pt is prescribed a Dopamine agonist (Mirapex) (adrenergic agonist)
for Parkinson’s
“This med will stop the progression of Parkinson’s.” – can’t cure
Parkinson’s
Pt with mild symptoms of Alzheimer’s is prescribed Donepezil (Aricept)
The drug will stop the damage to the neurons in my brain
Pt is concerned about developing Alzheimer’s disease
Naproxen (NSAID’s)
Which assessment best determines the effectiveness of Sumatriptan
(triptans are used for treatment of Migraines so…
Termination of the migraine
Pt with schizophrenia is prescribed chlorpromazine (Thorazine – first
generation antipsychotic) oral concentrate
The medication may cause excessive salivation
And No direct skin contact (both correct – not a good question)
Which best assessment best determines the pt is developing tardive
dyskinesia
Twisting, writhing, worm-like movements of tongue
Pt with depression is proscribed Fluoxitine (Prozac)
“It may take 3-4 weeks before my mood is elevated”
Pt is on Marplan (MAOIs – have the most food interactions) for
depression
Bananas, smoked fish, and cheese
Pt on Lithium
Polydypsia (increased thirst), slurred speech, and fine hand tremors
Pt is prescribed Lunesta for insomnia
Anterograde amnesia (memory loss of events right before taking drug)
A 24 yo female gets Triazolam (Halcion) for insomnia at home
(remember to use the process of elimination)
“The medication will not alter my breathing”
A pt is prescribed Venlafaxine and the pt asks what the purpose of
medication is, you should state
Depression and anxiety
A pt with OCD is prescribed Zoloft – which is not a true statement about
the medication
“I will get better in 3 weeks.” (full effect in 1 – 2 months, you won’t
get “better” necessarily)
An RN is teaching a parent about administration of aderol to treat their
child’s ADD
Give the dose in the morning b4 school. (amphetamine – child needs it
to concentrate)
Amphetamines can cause growth suppression in children
Provide snack or meal b4 giving med (because amphetamines
suppresses appetite)
Pt states that he’s on Oxycodone and the dose that he currently receives
does not provide the same pain relief
Tolerance
A pt with HF is getting Furosemide (Lasix) (loop diuretic is K+
wasting) Oranges, spinach, and potatoes
high in potassium
A client in renal failure asks why he is being given antacids
Calcium and aluminum antacids bind phosphates and help to keep
phosphates from
being absorbed into blood stream thereby preventing rising phosphate
levels, and
must be taken with meals
Receiving Digoxin for the onset supraventricular tachycardia (SVT)
hypokalemnia
Receiving Albuterol (Proventil) tablets complains of nausea every
evening with her 9pm
doseadminister the dose with a snack
The healthcare provider prescribes naloxone (Narcan) for a client in the
emergency room
The clients’ respiratory rate is 16 breaths/min
A client who has been taking levadopa PO Tid to control the symptoms
of Parkinson’s disease has a new prescription for sustained-release
levadopa/carbidopa (Simemet 25/100) PO Bid and took his levadopa at
0800
“You can begin taking the Sinemet this evening, but do not take any
more levadopa”
Which action is most important for the nurse to implement during the
administration of the antirrhythmic drug adenosine (Adenocard)
Apply continuous cardiac monitoring
Nurse is teaching a client with cancer about opioid management for
intractable pain and tolerance related side effects
Constipation
Which dosing schedule should the nurse teach the client to observe for a
controlled release oxycodone Rx
q12h
Parkinson’s Dz and is taking carbidopa-levodopa (Sinemet) indicate that
the desired outcome of the medication is being achieved
Lessening of tremors
Preparing the 0900 dose of losartan (Cozaar) an angiotension-II receptor
blocker (ARB) for a client with hypertension and heart failure
Withhold the scheduled dose
Taking hydromorphone (Dilaudid) PO q4h at home. Following surgery
Dilaudid IV q4h PRN and but butorphanol tartrate (Stadol) IV q4h PRN.
The pt received a dose of the drug 4 hours ago and is again requesting
pain medication
Administer only the Dilaudid q4h PRN for pain
Dobutamine (Dobutrex) is an emergency drug most commonly
prescribed for which condition
Heart failure
Giardiasis is taking metronidazole (Flagyl) 2 grams PO
Take the medication with food
The nitrate isosorbide denitrate (Isordil) is prescribed for a client with
angina
Do not get up quickly, always rise slowly
Reviewing the use of the patient controlled analgesics (PCA) pump with
a client in the immediate postoperative period The client will receive
Morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes
per PCA to total 5 mg IV maximally per hour
The rate and depth of the clients’ respirations
A peak and trough level must be drawn for a client receiving antibiotic
therapy
Immediately before the next antibiotic dose is given
When assessing an adolescent who recently overdosed on
acetaminophen (Tylenol), it is most important for the nurse to assess for
pain in which area of the body
Abdomen
A client has myxedema which results from a deficiency of thyroid
hormone synthesis in adults
Pentobarbital sodium Nembutal Sodium for sleep
Receiving ampicillin sodium (Omnipen) for a sinus infection
Rash
A client is being treated for osteoporosis with alendronate (Fosamax)
and the nurse has completed discharge teaching regarding medication
administration
Take medication, go for a 30 minute morning walk, then eat breakfast
Continuous IV infusion of dopamine (Intiropin) and an IV of normal
saline at 50 ml/hr the nurse notes that the clients urinary output has been
20 ml/hr for the last 2 hours
Notify the healthcare provider of the urinary output
Which change in data indicates to the nurse that the desired effect of the
angiotension II receptor antagonist valsartan (Diovan) has been achieved
Blood pressure reduced from 160/90 to 130/80
A healthcare provider prescribes cephalexin monohydrate (Keflex) for a
postoperative infection
Penicillins
Prescription for a scopolamine patch (Transderm Scop) to prevent
motion sickness while on a cruise
Apply the patch at least 4 hrs prior to departure
Which antidiarrheal agent should be used with caution in clients taking
high dosages of aspirin for arthritis
Bismuth subsalicylate (Pepto Bismol)
Prescriptions for morphine sulphate 2.5 mg IV q6h and ketorolac
(Toradol) 30 mg IV q6h
administer both medications according to the
prescription
Hyperlipidemia receives a prescription for niacin (Niaspan)
Expected duration of flushing
Which drug is used as a palliative treatment for a client with tumor-
induced spinal cord compression
Dexamethasone (Decadron)
Admission to the emergency center, an adult client with acute status
asthmaticus is prescribed this series of medications In which order
Albuterol (Proventil) puffs
Salmeterol (Serevent Diskus)
Prednisone (Deltasone) orally
Gentamicin (Garamycinim) IM
43-year-old female receiving thyroid replacement hormone following a
thyroidectomy
Tachycardia and chest pain
Receiving clonidine (Catapres) 0.1 mg q24h via transdermal patch
Blood pressure changed from 180/120 to 140/70
Which nursing Dx is important to include in the plan of care for a client
receiving the angiotension II receptor antagonist irbesartan (Avapro)
Risk for injury
Osteoarthritis receives a new prescription for celecoxib (Celebrex) orally
for symptom management. The nurse notes the client is allergic to sulfa
Notify the healthcare provider
In evaluating the effects of lactulose (Cefulac)
Two or three soft stools per day
Patient with dysrhythmia is to receive procainamide (Pronestyl) in a 4
divided dose over the next 24 hours
Q6h
The nurse is transcribing a new prescription for spironolactone
(Adactone) for pt who receives an angiotension-converting enzyme
(ACE) inhibitor
Verify both prescriptions with the healthcare provider
Admitted to the coronary care unit with a medical Dx of acute
myocardial infarction
Nitroglycerin
After abdominal surgery prescribed low molecular weight heparin
(LMWH)
This medication is a blood thinner given to prevent blood clot
formation
An antacid, (Maalox) is prescribed for a client with peptic ulcer Dz
Maintain a gastric pH of 3.5 or above
Pt states “I am allergic to penicillin”
Cephalosporins
A category X drug is prescribed for a young adult female client
Use a reliable form of birth control
Admitted to the hospital for Dx testing for possible myasthenia gravis
prepares for IV administration of edrophonium chloride (Tensilon)
Decreases muscle weakness
Which symptoms are serious adverse affects of Beta-adrenergic blockers
such as propranolol (Inderal)
Wheezing, hypotension and AV block
Prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at
the clinic complaining of muscle pain and weakness in his legs
Make an appointment to see the healthcare provider because muscle
pain may be a serious side effect
The healthcare provider prescribes naproxen (Naproxen) twice daily for
a client with osteoarthritis of the hands
Another type of non- steroidal anti-inflammatory drug may be
indicated
Dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg
PO daily
administer the 60 mg dose of Imdur and a PRN dose of
acetaminophen (Tylenol)
Coronary artery Dz. is taking digoxin (Lanoxin) receives a new
prescription for atorvastatin (Lipitor)
Vomiting
A client is being treated for hyperthyroidism with propylthiouracil
(PTU)
Inhibit synthesis of T3 and T4 by the thyroid gland
Following sublingual nitroglycerin to a pt experiencing an acute anginal
attack
Client states chest pain is relieved
Spironolactone (Aldactone) for heart failure is Rx
Refrain from eating foods high in potassium
Medication described as a Beta1 agonist is most commonly prescribed
for a client with which condition
Heart failure
Assessing a client that is experiencing anaphylaxis from an insect sting
Epinephrine
Instruction to give to a female who just received a Rx for oral
metronidazoleI(Flagyl) for treatment of trichomonas vaginalis
Increase fluid intake, especially cranberry juice
Avoid drinking alcohol while taking this medication
Use condoms until Tx is completed
Ensure that all sexual partners are Tx at the same time
Receiving doxorubicin (Adriamycin) IV complains of pain at the
insertion site and the nurse notes edema at the site
D/C IV fluids
Assessing the effectiveness of high dose aspirin therapy for an 88-year-
old client with arthritis
Notify the healthcare provider of this finding immediately
Pt asks the nurse if glipizide (Glucotrol) is oral insulin
No, it is not oral insulin and can be used only when some Beta cell
function is present
Which medication should the nurse caution the client about taking while
receiving an opioid analgesic
Benzodiazepines
Postoperative and has been receiving a continuous IV infusion of
mepreidine (Demerol) 35 mg per hr for 4 days and has a PRN Rx for
Demerol for 100 mg PO q3h
Decrease the IV infusion rate of the mepreidine (Demerol) per
protocol
Congestive heart failure (CHF) is being discharged with a new Rx for
the angiotension-converting enzyme (ACE) inhibitor captopril (Capoten)
Dizziness
Heparin Tx for a pulmonary embolism a client is being discharged with
a Rx for warfarin (Coumadin)
Prothrombin Time (PT/INR)
Receiving metoprolol (Lopressor SR)
Blood pressure
Teaching for liver transplant about cyclosporine (Sandimmune) the
nurse should encourage the pt to report which adverse response
Presence of hand tremors
Older client with a decreased percentage of lean body receives a Rx that
is adjusted based on which pharmacokinetic process?
Distribution