NR 447 RN Capstone Pharmacology Exam | Questions and Answers | Latest Update | GRADED A

ATI Pharm 1 Remediation Capstone 1. A nurse is caring for a client who has a prescription for digoxin. What are manifestations for digoxin toxicity that the nurse should monitor for before administering this medication? a. Toxicity- fatigue, weakness, vision changes, GI changes, dysrhythmias, bradycardia b. Monitor before administration- Pulse rate and rhythm, notify if less than 60 bpm, Monitor levels should be 0.5-0.8 ng/mL 2. A nurse is preparing to administer a topoisonmerase inhibitor to a client with ovarian cancer. What are adverse effects the nurse should monitor when administering this medication? a. Kill cancer cells by interrupting DNA synthesis b. Bone marrow suppression- monitor WBC, absolute neutrophil count, platelet count, Hgb, and Hct. Assess for bruising and bleeding gums. Instruct clients to avoid crowds and contact with infectious individuals. Advise clients to continue precautions after treatment is completed. c. GI discomfort (N/V) d. Alopecia- can occur 7-10 days after beginning e. Monitor for bleeding, infection, CBC, give antiemetic, good oral care, avoid alcohol-based mouth wash, advise females to use birth control 3. A nurse has provided education to a client who has a new prescription for exenatide. What statements by the client would indicate they understand the instructions? a. Exenatide is an incretin mimetic b. Promotes release of insulin, decreases secretion of glucagon, slows gastric emptying c. Can cause N/V/D d. Pancreatitis- severe intrabdominal pain, withhold medication e. 60 mins before morning and evening meal, keep in fridge, discard after 30 days 4. A nurse has provided education to a client with hypothyroidism who has a new prescription for levothyroxine. What statements by the client would indicate they understand the instructions? a. Synthetic thyroid hormone b. Overuse can result in signs of hyperthyroidism- anxiety, tachycardia, palpitations, altered appetite, cramping, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities 5. A nurse is caring for a client who has a new prescription for alosetron. What are the expected therapeutic effects of this medication? a. For IBS w/ diarrhea b. Can cause GI toxicity- ischemic colitis, bowel obstruction, impaction, or perforation, watch for bleeding, cramping, diarrhea 6. An oncology client is prescribed filgrastim. What are the indications for this therapy? a. Leukopoietic growth factors stimulate the bone marrow to increase production of neutrophils b. Used for cancer patients with neutropenia, or prior to autologous transplant 7. A nurse is placing an IV line on an older adult client. List three (3) considerations the nurse should take when placing an IV line in this client? a. Use correct size catheter for type of fluid going through line b. Older adults have fragile veins, avoid tourniquet and use BP cuff c. Avoid using back of client’s hand 8. A client with hypertension is prescribed verapamil. What are the three (3) expected outcomes of this medication therapy? a. Decrease force of contraction b. Decrease heart rate c. Slow rate of conduction through SA and AV nodes 9. A critical care client is in need of adenosine. What is the indication of this medication and how is this medication administered? a. Used for Paroxysmal SVT, Wolff-Parkinson-White syndrome b. Adenosine has a very short half-life, so adverse reactions are mild and last for less than 1 min. c. Administration should be by IV bolus, flushed with saline following administration 10. A home health nurse is evaluating the client's knowledge of the medication terazosin. Which statement by the client alerts the nurse the client needs further education on this medication? "I will take my medication at bedtime"."This medication will help my urinary output.""I will get out of bed slowly when waking.""I will take this medication after eating." a. Take this medication after eating indicates a need for further teaching b. Terazosin will increase urinary output, can case hypotension so they should get out of bed slowly, and they should be taking it daily before bedtime 11. A client is to take metronidazole. List three (3) teaching points to review with the client prior to administering the first dose. a. Can cause nausea, vomiting, dry mouth, and a metallic taste b. It can darken urine c. Avoid alcohol, it can cause flushing, vomiting, tachycardia, and dyspnea 12. The client has been ordered ranitidine. List three (3) teaching points to discuss with the client prior to the first administration. a. Can result in constipation, diarrhea, and vomiting b. Don’t take an antacid 1 hour before or after taking this c. Avoid aspirin and other NSAIDS 13. During a home visit, a client asks the nurse what the medication, zidovudine is and information of its side effects. What will the nurse teach the client about this medication? a. It is an antiretroviral and decreases the side effects of HIV b. Side effects can include bone marrow suppression, lactic acidosis, N/V/D, and hepatomegaly 14. A client is prescribed topical acyclovir. When teaching a client about application of the medication and management of the infection, what are three (3) points to discuss? a. Put on rubber gloves when applying b. Instruct clients to wash affected area with soap and water three to four times per day and to keep the lesions dry after washing. c. Advise clients to refrain from sexual contact while lesions are present 15. A client with hypokalemia is ordered potassium chloride. Identify three (3) points to teach the client about prior to the first dose. a. Take medication with meals and at least 8 oz of water b. Do not dissolve table in mouth c. Do not crush extended release tablets Antiemetics An antiemetic is a medication used in the treatment and/or prevention of nausea and vomiting. Remember generic names are our friend because meds in the same classification often have similar generic names but brand names can come and go. Here are some common classes of antiemetics and their generic names – notice the similarities in the generic names: 5-HT3 receptor antagonists (serotonin antagonists) Dolasetron (Anzemet) Granisetron (Kytril , Sancuso) Ondansetron (Zofran) Tropisetron (Navoban) It’s ‘Tron’ to the rescue! Dopamine antagonists Promethazine (Phenergan) Prochlorperazine (Compazine) Metoclopramide (Reglan): Now this one is different in generic name because it can have some different side effects – watch for extra-pyramidal side effects with metoclopramide. Sometimes the generic names are not as helpful and you have to remember what meds fall under certain classes. Antihistamines and cannabinoids are used as antiemetics as well: Antihistamines (H1 histamine receptor antagonists) Diphenhydramine (Benadryl) Dimenhydrinate (Gravol, Dramamine) Meclozine (Bonine, Antivert) Cannabinoids Cannabis - Medical marijuana, in the U.S., it is a Schedule I drug. Dronabinol (Marinol) - a Schedule III drug in the U.S. *Remember most antiemetics can cause sedation so watch out for additive effect if given with narcotic analgesics and protect your client from injury. Proton Pump Inhibitors (PPIs) PPIs decrease stomach acid by inhibiting those gastric proton pumps that make the acid – they stop the acid at the pump! Remember generic names are our friends because meds in the same class often have similar generic names but brand names come and go: Here are some common PPIs- Omeprazole (brand names: Prilosec, Zegerid, Omepral, Omez) Lansoprazole (brand names: Prevacid, Zoton, Inhibitol) Dexlansoprazole (brand name: Kapidex, Dexilant) Esomeprazole (brand names: Nexium, Esotrex) Pantoprazole (brand names: Protonix, Somac, Pantozol, Zentro) Think of a pump in your stomach just churning out the acid – ‘Zole’ is the nice guy who shuts off the pump. ‘Zole’ is very friendly (well-tolerated by most clients) but can cause vitamin B-12 deficiency if he stays around too long (with long-term use). Erectile Dysfunction Agents Erectile dysfunction (ED) meds act by increasing nitric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow (helping lead to getting and keeping an erection). Here is where the generic name is our friend again – meds in the same class often have similar generic names but brand names will come and go: Here are some common ED meds- Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Notice these end in ‘fil’. ‘Fil’ helps the nitric oxide to ‘fil’ the penis. While ‘Fil’ is a great guy (well-tolerated by most clients) he does have a few side effects – headache, flushing, back pain and muscle aches (with Levitra), temporary vision changes, including "blue vision" (with Viagra) and not all men can spend time with ‘Fil’. Men who have heart problems, uncontrolled blood pressure problems, history of stroke, or a health problem at can cause priapism can’t hang out with ‘Fil.’ Antianemics There are many causes of anemia and the antianemic prescribed will be based upon the cause. With iron deficiency anemia, iron supplements are commonly prescribed. Beware though - Iron is ‘heavy’ stuf f and shouldn’t be taken ‘lightly’! · Iron can cause teeth staining (liquid form). Teach clients to dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing. · Iron can cause staining of skin and other tissues with IM injections. If IM route must be used, give IM doses deep IM using Z track technique. · Iron also has several drug administration interactions- of antacids or tetracycline’s reduces absorption of iron. Separate use by at least 2 hr. · Vitamin C increases absorption, but also increases incidence of GI complications. Avoid vitamin C intake when taking medication. · Instruct clients to take iron on an empty stomach such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. However, iron can cause GI distress(nausea, constipation, heartburn) If intolerable, iron can be administered with food to increase compliance with therapy but this does reduce absorption. · Instruct clients to space doses at approximately equal intervals throughout day to most efficiently increase red blood cell production. · Inform clients to anticipate a harmless dark green or black color of stool. · Instruct clients to increase water and fiber intake (unless contraindicated), and to maintain an exercise program to counter the constipation effects. · Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast). Statins HMG CoA Reductase Inhibitors also known as ‘statins’ are some of the most prescribed medications in this country. Statins are used to treat primary hypercholesterolemia, for prevention of coronary events (primary and secondary), for protection against MI and stroke for clients with diabetes, and to help increase HDL levels in clients with primary hypercholesterolemia. Remember LDL is the ‘bad’ cholesterol and HDL is the ‘good’ cholesterol (HDL helps keep the ’bad’ cholesterol from building up in artery walls). You want your LOW (LDL)LOW and your HIGH (HDL) HIGH. Statins are another example that generic names are our friends – check out these common ‘statins’- Atorvastatin (Lipitor) Simvastatin (Zocor) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin (Crestor) Fluvastatin (Lescol) While statins are a wonderful addition to our pharmaceutical arsenal, they are not without risk. When you think ‘statins’ think that we need to protect the liver and muscles stat: There is a risk of hepatotoxicity. It is important to obtain a baseline liver function and to monitor liver function tests after12 weeks and then every 6 months and to avoid alcohol. There is also a risk of myopathy and peripheral neuropathy. Clients should be told to report muscle weakness and/or aches, pain, tingling and tenderness. CK levels will be monitored periodically during treatment as well. Anticoagulants Anticoagulants prevent the formation of blood clots by interfering with the clotting cascade, thereby preventing coagulation. The use of this class of medications is contraindicated with active bleeding, such as with bleeding disorders, ulcers, or hemorrhagic brain injuries. HEPARIN and COUMADIN are the two main anticoagulant medications. See the acrostics below for helpful hints and important facts about these drugs. HEPARIN H eparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered IV or SQ. E noxaparin (Lovenox) is a low-molecular weight heparin. It has the same action as heparin, but has a longer half-life. It is administered via subcutaneous injection. P rotamine sulfate is the antidote for heparin. A dminister heparin when there is the likelihood of clot formation, such as with myocardial infarction or deep-vein thrombosis. R isk for bleeding is the major side effect that clients should be educated about. Clients should be educated to monitor for bleeding, including bleeding gums, bruises, hematuria, and petechiae. I nstruct clients to avoid corticosteroid use, salicylates, NSAIDs, green leafy vegetables, and foods high in Vitamin K. N ormal activated partial thromboplastin time (aPTT) is 20 to 36 seconds, but to maintain a therapeutic level of anticoagulation while on heparin, the aPTT should be 1.5 to 2 times the normal value (60 to 80 seconds). COUMADIN C oumadin (generic name Warfarin sodium) interferes with coagulation factors by antagonizing vitamin K. O ral administration is typically used. Clients may need continued heparin infusion via IV until therapeutic effect of Coumadin is experienced (may take3-5 days). U se is contraindicated in clients with low platelet counts or uncontrolled bleeding. M ephyton (trade name vitamin K) is the antidote for Coumadin. A dvise clients to avoid foods that are high in vitamin K, and avoid the use of acetaminophen, glucocorticoids, and aspirin. Clients should wear a medical alert bracelet indicating warfarin use. D oses are typically taken once daily. I NR and PT are monitored for clients who are taking Coumadin. Depending on intent of therapy, PT should be 1.5 to 2 times control and INR should be 2-3. Target INR is 3 to 4.5 for clients with a mechanical heart valve. N o Coumadin for pregnant women! Oral anticoagulants fall into Pregnancy Risk Category X. Heparin maybe safely used in pregnancy. Antiplatelets PRIORITY POINT: Recall that this class of medications increases a client’s risk for bleeding because of their prevention of platelet aggregation. Nursing interventions and client education focus on the client’s increased risk for bleeding. Names to Know: · Aspirin (Ecotrin) · Clopidogrel (Plavix) · Pentoxifylline (Trental) How they work: Antiplatelets prevent platelets from clumping together by inhibiting enzymes and factors that normally cause arterial clotting. What they are used for: These medications are used to prevent myocardial infarction and stroke. Low dose therapy (81 mg) is effective for prevention of strokes and MI. How are they given: These medications are most commonly taken orally. They may also be administered IV. Nursing Interventions: WATCH FOR BLEEDING. · These medications should be taken with food. · These medications should be used cautiously in clients with peptic ulcer disease and in clients with severe renal/hepatic disorders. What do clients who are taking these medications need to know? · Observe for signs of weakness, dizziness, and headache and report them if they occur. These may be signs of hemorrhagic stroke. · Bleeding time should be assessed carefully. Coffee ground emesis or bloody, tarry stools should be reported. Watch for bruising, petechiae, and bleeding gums. What interactions may occur? · Avoid concurrent use of mediations that enhance bleeding, including NSAIDs, heparin,and warfarin. · Corticosteroids should be avoided as they may increase aspirin effects. · Concurrent use of aspirin may reduce hypertensive action of beta blockers. Thrombolytic Agents In order to truly appreciate this drug tip, you need to familiarize yourself with the Ghostbusters. If you haven’t heard the theme song, cue it up before reading further. We promise it will be worth it. PRIORITY POINT: If the Ghostbusters had a medication class of choice, this would be it! Thrombolytic Agents are CLOT BUSTERS. They work QUICKLY to restore circulation. As such, they increase a client’s risk for bleeding. Who you gonna call? Streptokinase (Streptase). Call right away! These medications must be administered within 4 to 6 hours of onset of symptoms. If there’s something strange in your neighborhood: Thrombolytic agents dissolve clots that have already been formed. These medications convert plasminogen to plasmin, which destroy fibrinogen and other clotting factors. What’s the goal? Restoration of circulation, as evidenced by relief of chest pain, and reduction of initial ST segment injury pattern as shown on ECG. What’s the risk? Increased bleeding. These medications should only be given while the client is closely monitored. Baseline platelet and blood counts (including aPTT, PT, and INR) shouldbe carefully assessed. Venipunctures and SQ and IM injections should be limited. After the clot has left the building: Administer beta blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias. Herb/Botanical Therapy Herbal supplements are widely used and have much less precise dosages than more regulated medications. Clients may not mention herbal supplements as a part of their medication history, so it is important to ask clients specifically if they are taking any supplements in addition to prescription or over the counter medications. Here are a few common herbal therapies: Echinacea: · Used to treat the common cold. · With chronic use, echinacea can decrease positive effects of medications for TB, HIV, or cancer. Ginger root: · Used to decrease nausea of morning sickness, motion sickness, and nausea induced by surgery. · May also decrease the pain and stiffness of rheumatoid arthritis. · These medications suppress platelet aggregation. · Should be used cautiously in pregnancy. Ginkgo biloba: · Promotes vasodilation and may be used to increase recall ability and mental processes. · Used commonly with dementia and Alzheimer’s Disease. · May also be used for erectile dysfunction in clients who take SSRIs and experience impotence as a side effect. · May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics. · May interfere with coagulation. Valerian: · Increases GABA to prevent insomnia. · Promotes sleep with increased effect over time. There is a risk of dependence. · May cause drowsiness and depression. · Should be used cautiously in clients with mental health disorders. · Avoid use in pregnancy or while breastfeeding. Black cohosh: · Acts on the female reproductive system as an estrogen substitute. · May be used instead of estrogen therapy during menopause. · Increases the effects of antihypertensive medications and may increase effect of estrogen medications. · Increases hypoglycemia in clients who are taking insulin or other medications for diabetes. THE BOTTOM LINE: Clients who are taking herbal supplements should be advised to speak to their provider about possible interactions or adverse reactions that may occur. Insulins Insulins are used to manage diabetes mellitus, a chronic illness that results from an absolute or relative deficiency of insulin. There are various insulins that are available to manage diabetes. For each type of insulin, you will need to know the onset, peak, and duration. NCLEX questions may focus on when clients need to be assessed after insulin administration. Assessment should occur frequently, but especially during the PEAK of insulin action, as this is when hypoglycemia is most likely to occur. Signs and symptoms ofabrupt-onset hypoglycemia include tachycardia, palpations, diaphoresis, and shakiness. Gradual onset hypoglycemia may manifest with headache, tremors, or weakness. We’ll CLIMB TO THE PEAK…starting FAST and ending SLOW. FASTEST: Rapid acting insulins:Lispro (Humalog). ONSET: Less than 15 minutes. PEAK: 30 minutes to 1 hour. DURATION: 3 to 4 hours. FAST: Short acting insulins: Regular (Humulin R). ONSET: 30 minutes to 1 hour. PEAK: 2 to 3 hours. DURATION: 5 to 7 hours. SLOW: Intermediate-acting insulins: NPH insulin (Humulin N). ONSET: 1 to 2 hours. PEAK: 4 to 12 hours. DURATION: 18 to 24 hours. SLOWEST: Long-acting insulins: Insulin glargine (Lantus). ONSET: 1 hour PEAK: None DURATION: 10 to 24 hours. Many students look for ways to more easily remember all of the ranges associated with insulin. It is helpful to think generally rather than trying to recall all exact numbers when memorizing this information, and, if you can only remember one thing about each insulin, CLIMB TO THE PEAK. Pick one number from each time frame (onset, peak, duration) to help reduce the values that you’re trying to memorize. Remember that onset, peak, and duration build sequentially as you move from one type of insulin to another, so it may be helpful to remember, for example, that onset times go from 15 minutes, to 30 minutes, to 1 hour (trend: all onsets are less than an hour). Peak times go from 30 minutes, to 2 hours, to 4 hours (trend: even numbers). Finally, duration goes from 3 hours, to 5 hours, to 24 hours. If you always organize your thoughts by O.P.D.(onset, peak, and duration), starting FAST (rapid acting) and ending SLOW (long acting) when studying the different types of insulin, these tips will be helpful. The key is consistency…looking at values in the same order every time. Test taking tips: Dealing with the dreaded ‘Select All That Apply’ question: These are tough. Try to make them true false questions so that you don't miss any correct choices. Read the question, read the first choice - ask yourself is it true or false (is it correct or not). If so check it. Read the question again and the next choice - ask yourself is it true or false. Is that true for all of the choices? Don’t allow the info from one answer choice influence you. Only the info in the stem of the question should be considered when picking your answers. Prioritization Tip: To avoid some common pitfalls when answering priority questions, be aware of the following: Never perform ABC checks blindly without considering whether airway, breathing or circulation issues are acute versus chronic or stable versus unstable. For example, a client who is quadriplegic and on a ventilator has chronic airway/breathing problems. However, if there is not an acute consideration such as pneumonia, the client should be considered chronic and stable. This client would not be the nurse’s first priority.