NUR 354 Pharmacology II Exam
#3 Review Arizona College School
of Nursing
1. Normal Prothrombin and INR Levels
• Prothrombin Time (PT): 11-13.5 seconds
• International Normalized Ratio (INR): 0.9-1.1 (for normal
individuals)
• For patients on anticoagulants, INR typically ranges from
2.0-3.0.
• Nursing Implication: Monitor INR regularly for patients
on warfarin to ensure therapeutic anticoagulation.
2. Normal LDL, HDL, Cholesterol, and Triglyceride Levels
• LDL (Low-Density Lipoprotein): Less than 100 mg/dL
• HDL (High-Density Lipoprotein): Greater than 40 mg/dL for men and
50 mg/dL for women
• Total Cholesterol: Less than 200 mg/dL
• Triglycerides: Less than 150 mg/dL
• Nursing Implication: Educate patients on the importance of diet
and exercise in managing cholesterol levels, especially for those on
statins.
3. Normal Potassium and Sodium Levels
• Potassium (K): 3.5 - 5.0 mEq/L
• Sodium (Na): 135 - 145 mEq/L
• Nursing Implication: Monitor electrolyte levels, especially in
patients on diuretics (e.g., Lasix) and ACE inhibitors.
4. Adverse Effects of Atorvastatin
• Common effects: muscle pain, weakness, liver enzyme
abnormalities, gastrointestinal issues.
• Rare but serious: rhabdomyolysis (muscle breakdown), elevated liver
enzymes.
• Nursing Implication: Monitor liver function tests (LFTs) and CK
levels in patients on atorvastatin.
5. Adverse Effects of Clopidogrel
• Common effects: bleeding, bruising, gastrointestinal discomfort.
• Serious effects: thrombocytopenic purpura (TTP).
• Nursing Implication: Monitor for signs of bleeding and educate
patients to report unusual bruising or bleeding.
6. Reasons to Withhold Metoprolol
• Withhold if:
o Heart rate is less than 50-60 bpm or BP is too low (systolic BP
less than 90 mmHg).
, o Severe bradycardia, heart block, or acute decompensated heart
failure.
o Patients with asthma or COPD (due to bronchoconstriction risk).
o Nursing Implication: Assess heart rate and blood pressure
before administration.
•
7. Priority Labs for Someone Receiving Lasix (Furosemide)
• Potassium: Risk of hypokalemia.
• Sodium: Watch for hyponatremia.
• Kidney function: Monitor BUN, creatinine.
• Magnesium levels: May also drop with diuretics.
• Nursing Implication: Regularly monitor electrolytes and kidney
function to prevent electrolyte imbalances and renal impairment.
8. Foods High in Vitamin K
• Leafy greens (e.g., spinach, kale, broccoli), Brussels sprouts, cabbage,
and certain vegetable oils.
• Nursing Implication: For patients on warfarin, ensure consistent
intake of Vitamin K.
9. Advantages of Using Rivaroxaban Versus Warfarin
• Rivaroxaban: Fixed dosing, no need for routine INR monitoring,
fewer food interactions.
• Warfarin: Requires frequent INR monitoring and has significant
dietary restrictions (Vitamin K).
• Nursing Implication: Educate patients on the ease of use with
rivaroxaban, but continue to monitor for bleeding risks
10. Labs Used for Warfarin
• INR (International Normalized Ratio): Therapeutic range is typically
2.0-3.0.
• Nursing Implication: Regularly monitor INR to ensure proper
dosing and prevent bleeding or clotting risks
11. Patient Education on Newly Diagnosed Hyperlipidemia and Use of
Statins
• Diet and lifestyle changes: Emphasize low-fat diet, exercise, and
smoking cessation.
• Medications: Adherence to statin therapy and monitoring for side
effects (e.g., muscle pain, liver dysfunction).
• Nursing Implication: Educate on the importance of routine
cholesterol monitoring
12. What to Assess in a Patient Taking Digoxin
• Heart rate: Hold if less than 60 bpm.
, • Signs of toxicity: Nausea, vomiting, visual disturbances
(yellow/green halos).
• Kidney function: Check BUN and creatinine.
• Nursing Implication: Monitor vital signs closely and assess for
digoxin toxicity.
13. Teaching Points for Someone Taking Warfarin
• Consistent diet: Maintain consistent Vitamin K intake.
• Monitor INR: Ensure therapeutic levels (usually 2.0-3.0).
• Signs of bleeding: Educate on recognizing bleeding and bruising.
• Nursing Implication: Reinforce patient education on drug
interactions and adherence to therapy.
14. What Needs to Be Monitored When Someone Is Receiving
Milrinone
• Heart rate and blood pressure: May cause hypotension and
arrhythmias.
• Electrolytes: Especially potassium levels.
• Renal function: Monitor creatinine and urine output.
• Nursing Implication: Monitor vital signs and electrolytes closely
during therapy.
15. Proper Steps in Self-Administration of SQ Heparin
• Clean injection site with alcohol.
• Pinch skin and insert needle at a 90-degree angle.
• Inject medication slowly, then dispose of needle properly.
• Nursing Implication: Provide patient education on self-injection
technique and signs of bleeding.
16. Proper Steps in Obtaining an Apical Pulse
• Place the stethoscope on the chest at the fifth intercostal space near
the midclavicular line.
• Count the beats for one full minute.
• Nursing Implication: Assess for abnormalities (e.g., irregular
rhythms, bradycardia, tachycardia).
17. Labs for Someone Taking Atorvastatin
• Liver function tests (ALT, AST): To monitor for hepatotoxicity.
• Creatine kinase (CK): To assess for muscle damage (rhabdomyolysis).
• Nursing Implication: Regularly monitor liver enzymes and muscle
function
18. What Does the Drug Alirocumab Do?
, • Alirocumab is a PCSK9 inhibitor that lowers LDL cholesterol by
increasing the liver's ability to remove LDL from the blood.
• Nursing Implication: Educate patients on the need for regular
cholesterol monitoring.
19. Can IV Lasix Cause Hearing Loss if Administered Too Fast?
• Yes, rapid infusion of IV Lasix (furosemide) can cause ototoxicity and
hearing loss.
• Nursing Implication: Administer slowly and monitor for signs of
ototoxicity.
20. Is the Medication Ezetimibe Used for Heart Failure?
• No, Ezetimibe is primarily used for lowering cholesterol, not heart
failure.
• Nursing Implication: Clarify the purpose of medications with
patients to ensure adherence.
21. Manifestations of Digoxin Toxicity
• Visual disturbances (yellow/green halos).
• Nausea and vomiting.
• Bradycardia.
• Nursing Implication: Monitor for signs of toxicity, especially if
patient is hypokalemic or has renal dysfunction.
22. Afterload, Preload, Cardiac Output – Definitions
• Afterload: The pressure the heart must overcome to eject blood.
• Preload: The volume of blood returning to the heart.
• Cardiac Output: The amount of blood the heart pumps per minute.
• Nursing Implication: Understand these concepts when managing
heart failure and circulatory conditions.
23. Adverse Effects of Ezetimibe
• Gastrointestinal discomfort (diarrhea, nausea).
• Liver enzyme elevation - Monitor LFTs.
• Muscle pain (rarely).
• Nursing Implication: Monitor for gastrointestinal side effects and
liver function.
24. Antidote for Rivaroxaban
• Andexanet alfa (Andexxa).
• Nursing Implication: Be prepared to administer antidote in the
event of life-threatening bleeding
#3 Review Arizona College School
of Nursing
1. Normal Prothrombin and INR Levels
• Prothrombin Time (PT): 11-13.5 seconds
• International Normalized Ratio (INR): 0.9-1.1 (for normal
individuals)
• For patients on anticoagulants, INR typically ranges from
2.0-3.0.
• Nursing Implication: Monitor INR regularly for patients
on warfarin to ensure therapeutic anticoagulation.
2. Normal LDL, HDL, Cholesterol, and Triglyceride Levels
• LDL (Low-Density Lipoprotein): Less than 100 mg/dL
• HDL (High-Density Lipoprotein): Greater than 40 mg/dL for men and
50 mg/dL for women
• Total Cholesterol: Less than 200 mg/dL
• Triglycerides: Less than 150 mg/dL
• Nursing Implication: Educate patients on the importance of diet
and exercise in managing cholesterol levels, especially for those on
statins.
3. Normal Potassium and Sodium Levels
• Potassium (K): 3.5 - 5.0 mEq/L
• Sodium (Na): 135 - 145 mEq/L
• Nursing Implication: Monitor electrolyte levels, especially in
patients on diuretics (e.g., Lasix) and ACE inhibitors.
4. Adverse Effects of Atorvastatin
• Common effects: muscle pain, weakness, liver enzyme
abnormalities, gastrointestinal issues.
• Rare but serious: rhabdomyolysis (muscle breakdown), elevated liver
enzymes.
• Nursing Implication: Monitor liver function tests (LFTs) and CK
levels in patients on atorvastatin.
5. Adverse Effects of Clopidogrel
• Common effects: bleeding, bruising, gastrointestinal discomfort.
• Serious effects: thrombocytopenic purpura (TTP).
• Nursing Implication: Monitor for signs of bleeding and educate
patients to report unusual bruising or bleeding.
6. Reasons to Withhold Metoprolol
• Withhold if:
o Heart rate is less than 50-60 bpm or BP is too low (systolic BP
less than 90 mmHg).
, o Severe bradycardia, heart block, or acute decompensated heart
failure.
o Patients with asthma or COPD (due to bronchoconstriction risk).
o Nursing Implication: Assess heart rate and blood pressure
before administration.
•
7. Priority Labs for Someone Receiving Lasix (Furosemide)
• Potassium: Risk of hypokalemia.
• Sodium: Watch for hyponatremia.
• Kidney function: Monitor BUN, creatinine.
• Magnesium levels: May also drop with diuretics.
• Nursing Implication: Regularly monitor electrolytes and kidney
function to prevent electrolyte imbalances and renal impairment.
8. Foods High in Vitamin K
• Leafy greens (e.g., spinach, kale, broccoli), Brussels sprouts, cabbage,
and certain vegetable oils.
• Nursing Implication: For patients on warfarin, ensure consistent
intake of Vitamin K.
9. Advantages of Using Rivaroxaban Versus Warfarin
• Rivaroxaban: Fixed dosing, no need for routine INR monitoring,
fewer food interactions.
• Warfarin: Requires frequent INR monitoring and has significant
dietary restrictions (Vitamin K).
• Nursing Implication: Educate patients on the ease of use with
rivaroxaban, but continue to monitor for bleeding risks
10. Labs Used for Warfarin
• INR (International Normalized Ratio): Therapeutic range is typically
2.0-3.0.
• Nursing Implication: Regularly monitor INR to ensure proper
dosing and prevent bleeding or clotting risks
11. Patient Education on Newly Diagnosed Hyperlipidemia and Use of
Statins
• Diet and lifestyle changes: Emphasize low-fat diet, exercise, and
smoking cessation.
• Medications: Adherence to statin therapy and monitoring for side
effects (e.g., muscle pain, liver dysfunction).
• Nursing Implication: Educate on the importance of routine
cholesterol monitoring
12. What to Assess in a Patient Taking Digoxin
• Heart rate: Hold if less than 60 bpm.
, • Signs of toxicity: Nausea, vomiting, visual disturbances
(yellow/green halos).
• Kidney function: Check BUN and creatinine.
• Nursing Implication: Monitor vital signs closely and assess for
digoxin toxicity.
13. Teaching Points for Someone Taking Warfarin
• Consistent diet: Maintain consistent Vitamin K intake.
• Monitor INR: Ensure therapeutic levels (usually 2.0-3.0).
• Signs of bleeding: Educate on recognizing bleeding and bruising.
• Nursing Implication: Reinforce patient education on drug
interactions and adherence to therapy.
14. What Needs to Be Monitored When Someone Is Receiving
Milrinone
• Heart rate and blood pressure: May cause hypotension and
arrhythmias.
• Electrolytes: Especially potassium levels.
• Renal function: Monitor creatinine and urine output.
• Nursing Implication: Monitor vital signs and electrolytes closely
during therapy.
15. Proper Steps in Self-Administration of SQ Heparin
• Clean injection site with alcohol.
• Pinch skin and insert needle at a 90-degree angle.
• Inject medication slowly, then dispose of needle properly.
• Nursing Implication: Provide patient education on self-injection
technique and signs of bleeding.
16. Proper Steps in Obtaining an Apical Pulse
• Place the stethoscope on the chest at the fifth intercostal space near
the midclavicular line.
• Count the beats for one full minute.
• Nursing Implication: Assess for abnormalities (e.g., irregular
rhythms, bradycardia, tachycardia).
17. Labs for Someone Taking Atorvastatin
• Liver function tests (ALT, AST): To monitor for hepatotoxicity.
• Creatine kinase (CK): To assess for muscle damage (rhabdomyolysis).
• Nursing Implication: Regularly monitor liver enzymes and muscle
function
18. What Does the Drug Alirocumab Do?
, • Alirocumab is a PCSK9 inhibitor that lowers LDL cholesterol by
increasing the liver's ability to remove LDL from the blood.
• Nursing Implication: Educate patients on the need for regular
cholesterol monitoring.
19. Can IV Lasix Cause Hearing Loss if Administered Too Fast?
• Yes, rapid infusion of IV Lasix (furosemide) can cause ototoxicity and
hearing loss.
• Nursing Implication: Administer slowly and monitor for signs of
ototoxicity.
20. Is the Medication Ezetimibe Used for Heart Failure?
• No, Ezetimibe is primarily used for lowering cholesterol, not heart
failure.
• Nursing Implication: Clarify the purpose of medications with
patients to ensure adherence.
21. Manifestations of Digoxin Toxicity
• Visual disturbances (yellow/green halos).
• Nausea and vomiting.
• Bradycardia.
• Nursing Implication: Monitor for signs of toxicity, especially if
patient is hypokalemic or has renal dysfunction.
22. Afterload, Preload, Cardiac Output – Definitions
• Afterload: The pressure the heart must overcome to eject blood.
• Preload: The volume of blood returning to the heart.
• Cardiac Output: The amount of blood the heart pumps per minute.
• Nursing Implication: Understand these concepts when managing
heart failure and circulatory conditions.
23. Adverse Effects of Ezetimibe
• Gastrointestinal discomfort (diarrhea, nausea).
• Liver enzyme elevation - Monitor LFTs.
• Muscle pain (rarely).
• Nursing Implication: Monitor for gastrointestinal side effects and
liver function.
24. Antidote for Rivaroxaban
• Andexanet alfa (Andexxa).
• Nursing Implication: Be prepared to administer antidote in the
event of life-threatening bleeding
