HENRY FORD PHARM TEST (COMPILED) QUESTIONS WITH ACTUAL SOLUTIONS!!

6 rights of medication administration - ANS-Right drug Right dose Right patient Right route Right time Right documentation Right Drug - ANS-Proper identification of the ordered drug is required. Check medication against the physicians order form. As a Registered Nurse, you have the responsibility before administering any medication, to ensure that the dose and drug is appropriate for the patient. You also have the responsibility to clarify orders, which are unclear or seem inappropriate for the clinical condition of the patient. Right Dose - ANS-The RN is responsible for checking the dosage of the drug, doing the appropriate calculations or conversions, and knowing the usual dosage. Right Patient - ANS-Proper identification of the patient is required before medication is administered. HFHS acceptable method for confirming identification consists of checking the patients first and last name and medical record number (MRN) on the identification band with the name and MRN on the Medication Administration Record (MAR). Right Route - ANS-Route of administration should be part of the physicians order. The RN is responsible for preparing and administering medications correctly by consulting the accompanying instructions from the pharmacy or drug company. Right Time - ANS-The RN is responsible for administering medications according to scheduled times if that is how the order is written. Instructing patients on the timing of self-administered drugs at home is also an important function for nurses. Instruct using exact times such as "take at 8:00 in the morning with food and 5:00 in the evening with food" rather than "take at meal times" since meal times can vary with different cultural groups. Right Documentation - ANS-The RN is responsible for documenting the administration of the prescribed medication with the information required in the appropriate location such as the Medication Administration Record (MAR) within the Electronic Health Record. In addition to the 6 rights there are some additional steps which include: - ANS-Drug information Patient information Distraction Communication Patient education - ANS--the names of medications and how to pronounce them -what the medications do -what they look like -how and when medications should be taken -possible side effects and food/drug interactions Who may issue a verbal order? - ANS--Licensed independent provider (MD, DO, NP, or DDS) -Other licensed healthcare professional (physician assistant) as a delegated act of a licensed independent prescriber When is a verbal order used? - ANS--true emergencies -when issuing a written or electronic order is no feasible (e.g. during sterile procedures) Who is permitted to receive a verbal order? - ANS-Physician Registered Nurse Physician Assistant Pharmacist Respiratory Therapist Verbal orders are not to be used under any circumstances for the prescription of: - ANS-antineoplastic agents Only the following categories of medications are acceptable as range orders: - ANS-Opioids and other analgesics Antitussives Antiemetics Antihypertensive's Antihistamines Anxiolytics Penicillin(s) - ANS-Amoxicillin, ampicillin, augmentin, nafcillin sodium, pipercillin sodium, penicillin G (aqueous), penicillin VK, trimox, unasyn Indications: penicillins are antibiotics used to treat many different types of infections, such as tonsillitis, pneumonia, ear infections, bronchitis, urinary tract infections, gonorrhea, and infections of the skin, just to name a few. Serious Adverse Effects: Anaphylaxis, neutropenia, leukopenia, thrombocytopenia, hepatotoxicity Nursing Considerations: Give with a full glass of water on empty stomach and do not give with acidic fruit juice - it decompresses PCN Patient Education: -Seek emergency medical treatment if they experience signs and symptoms of an allergic reaction such as: shortness of breath, hives, swelling of the lips, face or tongue, rash or fainting. -Contact your physician if they experience severe or bloody diarrhea and abdominal cramping if being discharged on penicillin. -Penicillin may decrease the effectiveness of birth control pills and a second method of birth control while taking penicillin may be necessary to ensure protecting unintentional pregnancy. Tetracyclines - ANS-Doxycycline(vibramycin), Minocycline, and tetracycline Indications: tetracyclines are antibiotics that are used for different types of bacterial infections including urinary tract infections, acne, gonorrhea, and chlamydia Serious Adverse Reactions: Neutropenia, thrombocytopenia, hepatotoxicity, superinfection, hemolytic anemia, anaphylaxis. Nursing Considerations: -effectiveness reduced with antacids, iron salts and foods high in calcium -give 1 hour before meals or 2 hours after meals -give with a full glass of water. adequate water should be taken with each dose to prevent irritation of the esophagus Patient Education: -warn to stay out of the sun, photosensitivity manifested by exaggerated sunburn -Do not use tetracyclines during tooth development, i.e., last trimester of pregnancy, neonatal period, and childhood until age 8- may cause permanent discoloration of teeth and may inhibit fetal skeletal growth. -Do not take dairy products, iron supplements, multivitamins, calcium supplements, antacids or laxatives within 2 hours of taking tetracyclines. These products may reduce the effectiveness of tetracyclines. -Throw away any unused tetracycline when it expires or when it is no longer needed. Do not take any tetracyclines after the expiration date printed on the label. Expired tetracyclines can cause a dangerous syndrome resulting in damage to the kidneys. -Stop taking the tetracycline and seem emergency medical attention if the patient experiences serious side effects such as an allergic reaction, severe headache, vision changes or confusion, liver damage, bleeding or bruising, or severe fatigue. -Inform doctor if any less serious side effects occur including nausea, vomiting, increased sensitivity of the skin to sunlight, swollen tongue, or yeast infection. Aminoglycosides - ANS-Amikacin, Gentamycin (Garamycin), Streptomycin, Tobramycin Indications: Aminoglycosides are antibiotics used to treat many different infections including serious infections. Infections such as cirrhosis, gonorrhea, pneumonia, septicemia, and urinary tract infections may be treated with aminoglycosides. Serious Adverse Reactions: Nephrotoxicity, ototoxicity, agranulocytosis, thrombocytopenia, neurotoxicity. Nursing Considerations: -Nephrotoxicity is a serious side effect of aminoglycosides. If these side effects are present, the physician must be contacted before administering this medication. Risk increases in patient with poor renal function and the elderly. Monitor patient's BUN, creatinine, increase/decrease in frequency of urination, and increased thirst for signs of nephrotoxicity. Nephrotoxicity is limited if given for less than 5 days. -Monitor patient for signs of ototoxicity. This may include tinnitus, hearing impairment, and vestibular symptoms such as dizziness, nystigmus, vertigo, and ataxia. Patient Education: -Do not take aminoglycosides without first talking to your doctor if you have: sulfite sensitivity, kidney disease, hearing loss or loss of balance due to ear problems, parkinsons disease or a neuromuscular disorder such as myasthenia gravis. -Do not use aminoglycosides without first talking with your doctor if you are pregnant or could become pregnant during treatment. -Aminoglycosides may cause damage to the kidneys and/or nerves. Kidney function and drug levels in the blood may be monitored with blood tests during treatment. -Tell your doctor if you experience hearing loss, dizziness, numbness, skin tingling, muscle twitching, or seizures, which may be signs of nerve damage. Quinolones - ANS-Ciprofloxacin (Cipro), Levofloxacin (Levaquin) Indications: Quinolones are used to treat many different types of infections such as bronchitis, community acquired pneumonia, chronic bacterial prostatitis, UTI, and sinusitis. Serious Adverse Reactions: Anaphylaxis, hypersensitivity reaction, phototoxicity, superinfection, increased ICP, seizures. Nursing Considerations: -Use with caution in renal or liver failure, geriatrics and with seizure disorders -Administer 2 hours before or after antacids, iron supplements, and multivitamins -Encourage plenty of fluids to minimize risk of crystalloids -Pediatric use not recommended -Avoid using with drugs used to treat heart rhythm disturbances (irregular heartbeats) with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestryl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others. Combinationof quinolones and these drugs may prolong the QT interval and lethal dysrhythmias may result. Patient education: -Before taking levofloxacin, tell your doctor if you: have kidney disease, have a seizure disorder, have a heart condition known as prolongation of the QT interval, have a slow heart rate that is considered a medical condition, have low levels of potassium in your blood, are being treated for heart rhythm disturbances (irregular heartbeats) with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (pronestyl, procan SR, others), amiodarone (cordarone, pacerone, others), sotalol (betapace), and others. -Levofloxacin is in the FDA pregnancy category C. This means that it is not known whether levofloxacin will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. -It is not know Cephalosporins - ANS-First Generation: cefazolin (Ancef, Kefzol), cefadroxil (Duricef), cephalexin (Keflex) Second Generation: cefamandole(Mandol), cefuroxime (Zinacef), cefoxitin (Mefoxin), cefotetan (Cefotan), cefuroxime (Ceftin), cefonicid (Monocid), cefmetazol (zefazone) Third Generation: ceftizoxine (Cefizox), cefoerazone (Cefobid), cefprozil (cefzil), cefotaxine (claforan), ceftazidine (fortaz), ceftriaxone (rocephin), cefixime (suprax), cefpodoxine (vantin) Fourth Generation: cefepime (maxipime) Indications: cephalosporins may be used to treat different types of bacterial infections such as bronchitis, pneumonia, blood infections, bone and joint infections, meningitis, abdominal infections, skin infections, ear infections, gonorrhea, pelvic inflammatory disease, and urinary tract infections. Serious Adverse Reactions: anaphylaxis, severe nausea, vomiting or diarrhea, mucus or blood in the stool, unusual bleeding or bruising. Nursing Considerations: -broad-spectrum antibiotic structurally related to PCN. Ask about PCN allergies. -if allergic to PCN, third-generation may be tolerated. Use with caution. -cephalosporins are rapidly absorbed by mouth, intramuscularly, and intravenously -they all have similar sounding and similarly spelled names. Use care when transcribing others and request clarification as needed. -persistent temperature elevations may be indicative of drug induced fever. -prolonged serum half-life (15 hours) and reduced total clearance in the elderly. Patient Education: -before using cephalosporins, tell your doctor if you have had kidney disease, liver disease, bleeding or clotting problems, gastrointestinal disease such as colitis or gallbladder problems -May decrease effectiveness of birth control pills and a second method of birth control while taking penicillin may be necessary to ensure protection from unintend Macrolides - ANS-Erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin/sulfisoxazole Indications: Macrolides are used to treat many different types of bacterial infections, such as tonsillitis, bronchitis, pneumonia, whooping cough, legionnaires disease, chlamydia, gonorrhea, skin infections, and others Serious Adverse Reactions: Anaphylaxis, hepatotoxicity, thrombophlebitis, ventricular arrhythmias, bradycardia, hypotension Nursing Considerations: -Monitor the patient for an allergic reaction with the combination erythromycin and sulfisoxazole if the patient has ever had an allergic reaction to diuretics, a sunscreen containing PABA, or sulfonamide -Monitor for signs of overdose that may include decreased appetite, nausea, vomiting, diarrhea, dizziness, headache, abdominal discomfort, drowsiness, fever, and unconsciousness -give medication with a full glass of water and encourage increase fluid intake daily unless contraindicated -Monitor patient for a regular pulse or arrhythmias if on a cardiac monitor -if I monitor, be sure to measure the QT interval and notify physician if the interval is prolonged Patient Education: -take the medication exactly as ordered by the physician -do not take is pregnant without consulting your physician -do not take Seldane, Hismanal, Propulsid, or Orap. These medication may interact resulting in dangerous or life-threatening a regular heartbeats -avoid prolonged exposure to sunlight. The medication may increase the sensitivity of the skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable Sulfonamides - ANS-Trimethoprim/sulfamethoxazole (Bactrim DS, Bactrim SS, Septra DS) Indications: so far no minds are used to treat infections such as urinary tract infections, bronchitis, ear infections (otitis), travelers diarrhea, and pneumocystic carinii pneumonia Serious Adverse Reactions: hypersensitivity reactions, such as Stevens Johnson syndrome. Hematopoetic disorders, such as acute hemolytic anemia. Urinary tract abnormalities such as the deposit of sulfonamide crystals within the tissue of the urinary tract. Hepatitis rarely; focal or diffuse necrosis of the liver Nursing Considerations: Monitor for overdose symptoms which may include nausea, vomiting, decreased appetite, diarrhea, headache, yellowing of the skin arise, decreased urine production, bloody urine, and coma Patient Education: -this medication affects folic acid in your body, which is necessary for the normal development of a baby. Do not take sulfamethoxazole and trimethoprim without first talking to your doctor if you are pregnant -Sulfamethoxazole and trimethoprim passes into breast milk and may harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. -Sulfamethoxazole and trimethoprim is not approved for use in children younger than two months of age -take each dose with a full glass of water -avoid prolonged exposure to sunlight. Sulfamethoxazole and trimethoprim May increase the sensitivity of your skin to sunlight. Use sunscreen and wear protective clothing when I get exposure to the sun is unavoidable -stop taking sulfamethizole and trimethoprim and seek emergency medical attention if you experience any of the following serious side effects: allergic rea