NLN MEDICATION EVALUATION EXAM 2025/2026
QUESTIONS AND ANSWERS GRADED A++
✔✔Treating Diabetes in Children - ✔✔Hypoglycemic reaction often occurs before meals
or when insulin peaks
Teach child to wear a bracelet or tag and how to give injection - 90 degree angle
Teach only essentials first (14-20 minute sessions)
have the same meal as a normal child - time intake of food; eat at same time of day
Can assume responsibility for self-management at age 4-5
Age 9 - give own insulin injection with supervision
No exercise restrictions! Have extra snacks before and after exercise! Exercise
decreases need for insulin
Carry source of glucose at all times
after glucagon injection vomiting may occur - place on side to prevent aspiration
✔✔Preferred way to treat Ketoacidosis - ✔✔Insulin IV low-dosing
run a mixture of insulin through tubing before starting the drip - can chemically bind to
plastic
Replace fluid over 24-48 hours
✔✔IV Insulin Administration - ✔✔Can only be done with regular insulin in management
of DKA and HHNK
Premature discontinuation can cause prolongation of DKA
Begin sub-q therapy before stopping infusion - if not may have prolonged hyperglycemia
✔✔Common meds for HIV Treatment - antiretroviral - ✔✔Abacavir (Ziagen)
Stavudine (Zerit)
Zidoudine (AZT)
✔✔Antiviral Protease Inhibitor - ✔✔Ends in AVIR
Use prophylactically
Use in combination to decrease viral load and increase CD4
✔✔Reverse Transcriptase Inhibitors - ✔✔Ends in INE
Stops replication/growth
Reduces viral load
Advantage: do not adversely affect development of blood vessels
Use in combination with other meds because resistant strains may rapidly evolve
Inhibits cell protein synthesis hat interferes with viral replication
Blocks protease activity in HIV
✔✔Side Effects of HIV Treatment - ✔✔Assess for opportunistic infection (cancer,
neurological disease)
Headache
Fatigue
,Nausea
Vomiting
Diarrhea
Abdominal discomfort
Anemia
Taste Perversion
Asthenia
Circumoral Parestehsia with ritonivair
✔✔Adverse Reactions/Toxicity with HIV Therapy - ✔✔Hepatotoxicity: AST, ALT,
bilirubin
- N/V, jaunidce, upper right quadrant enlargement and tenderness
- Reduce dose with liver dysfunction
Nephrotoxicity: creatine, BUN, creatinine clearance, urinalysis
- Keep accurate I/O
- Monitor for SE off neutropenia
- Observe signs of occult infection - lower back, flank, suprapubic pain; normal temp or
low-grade fever r/t UTI
✔✔When to Start HIV Therapy - ✔✔1. All symptomatic HIV people (presenting with a
AIDS-defining illness)
2. CD4 count <350 mm^3
3. Pregnant women (AZT is used to prevent maternal transmission of HIV)
STOP if severe rash or other HS reaction occurs
Treatment will be long-term
✔✔Teaching for HIV Therapy - ✔✔Use neutropenic precautions
Eat small frequent meals with complete or complementary proteins
✔✔Positive Inotropic Meds - ✔✔Increase cardiac contractility
Ex: epinephrine, norepinephrine, dopamine
✔✔Negative Inotropic Meds - ✔✔Decrease cardiac contractility, lower BP
Ex: quinidine, beta blockers
✔✔Sulfonamides - ✔✔Anti-infective
Bacteriostatic
Action on bacteria results from interference with the functioning of enzyme systems
necessary for normal metabolism, growth, and multiplication
Treats: UTI, Chlamydia causing blindness, pneumonia, brain abscess, ulcerative colitis,
active Crohn's Disease, Rheumatoid Arthritis
Ex: Bactrim
,✔✔Side Effects of Sulfonamides - ✔✔Rash common - most are utricaria and
maculopapular
GI symptoms
Bone marrow depression
HA
Dizziness/vertigo
Ataxia
Convulsion
Depression
✔✔Adverse Effects/Toxicity of Sulfonamides - ✔✔Hepatotoxicity
Nephrotoxicity
Stevens Johnson Syndrome
✔✔Cautions with Sulfonamides - ✔✔Do not use if:
- Known allergies to sulfa drugs
- In polyuria, advanced renal or hepatic dysfunction
- With intestinal and urinary blockage
- Asthma
Adequate fluid intake (3,00-4,000 mL/day) to promote urinary output, at least 1,500
mL/d to prevent crystalluria/stone formation
May be taken after meals to prolong time in intestine
Collect C/S prior to beginning therapy
✔✔Thiazdie Diuretics - ✔✔Ex: Chlorothiazide (Hydrodiruil), Hydrochlorothiazide (HCTZ,
Diuril)
Ends in -ZIDE
Non-potassium sparing diuretic
Acts on distal tubes, blocks reabsorption of sodium, chloride, and water. Leads to
increased loss of potassium
Use for edema and mild to moderate HTN
Will see effect within 1-4 weeks
✔✔Side Effects with Thiazide Diuretics - ✔✔Dizziness, vertigo, HA, weakness,
dehydration, orhtostatic hypotension
N//V, abdominal pain, diarrhea, constipation, frequent urination
Dermatitis and rash
Electrolyte imbalance
Impaired glucose tolerance
✔✔Adverse Effects/Toxicity of Thiazide Diuretics - ✔✔Renal Failure
Aplastic anemia
Agranulocytosis
Thrombocytopenia
Anaphylactic reaction
, ✔✔Cautions with Thiazdie Diuretics - ✔✔Take early in the day to avoid nocturia
Take with food to avoid GI upset
Thiazide is ineffective if creatinine clearance is <30 mL/min
Eat foods high in K+
Restrict sodium - do not use salt substitute if taking K+-supplement
Weigh self daily and report sudden weight gains or losses
Avoid use with children and anuria
✔✔Tricyclic Antidepressants - ✔✔initial mechanism takes 1-3 weeks to develop
Maximum response is achieved in 6-8 weeks
Long half-life
Most end in -INE
- Nortyrptyine (Pamelor)
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Impipramine (Tofranil)
Blocks the reuptake of NE or 5HTs or both, leaving more available in the CNS. It
intensifies the effect of NE and 5HT which can elevate mood, increase activity and
alertness, decrease preoccupation with morbidity, improve appetite and regulate sleep
pattern
It is used to treat insomnia, attention deficit/hyperactivity and panic disorder
Take it at night - causes sedation
Do not take with MAO - causes hypertensive crisis from excessive adrenergic
stimulation of heart and blood vessels
Monitor orthostatic BP of patient in hospital
✔✔Side Effects of Tricyclic Antidepressants - ✔✔Orthostatic Hypotension
Sedation and anticholinergic effects
✔✔Adverse Effects/Toxicity of Tricyclic Antidepressants - ✔✔Most serious = cardiac
toxicity
in absence of overdose or preexisting cardiac impairment, serious cardiac impairment is
rare
Urinary retention is urgent
OD can cause convulsions
✔✔Cautions with Tricyclic Antidepressants - ✔✔Use with caution...Glaucoma, elderly,
constipation, prostatic hyperplasia (more sensitive to anticholinergic effect)
Avoid use with: hypersensitivity, MI, CV disease
✔✔Hepatitis - ✔✔Inflammation of the liver caused by virus, bacteria or exposure to
meds or hepatotoxins
QUESTIONS AND ANSWERS GRADED A++
✔✔Treating Diabetes in Children - ✔✔Hypoglycemic reaction often occurs before meals
or when insulin peaks
Teach child to wear a bracelet or tag and how to give injection - 90 degree angle
Teach only essentials first (14-20 minute sessions)
have the same meal as a normal child - time intake of food; eat at same time of day
Can assume responsibility for self-management at age 4-5
Age 9 - give own insulin injection with supervision
No exercise restrictions! Have extra snacks before and after exercise! Exercise
decreases need for insulin
Carry source of glucose at all times
after glucagon injection vomiting may occur - place on side to prevent aspiration
✔✔Preferred way to treat Ketoacidosis - ✔✔Insulin IV low-dosing
run a mixture of insulin through tubing before starting the drip - can chemically bind to
plastic
Replace fluid over 24-48 hours
✔✔IV Insulin Administration - ✔✔Can only be done with regular insulin in management
of DKA and HHNK
Premature discontinuation can cause prolongation of DKA
Begin sub-q therapy before stopping infusion - if not may have prolonged hyperglycemia
✔✔Common meds for HIV Treatment - antiretroviral - ✔✔Abacavir (Ziagen)
Stavudine (Zerit)
Zidoudine (AZT)
✔✔Antiviral Protease Inhibitor - ✔✔Ends in AVIR
Use prophylactically
Use in combination to decrease viral load and increase CD4
✔✔Reverse Transcriptase Inhibitors - ✔✔Ends in INE
Stops replication/growth
Reduces viral load
Advantage: do not adversely affect development of blood vessels
Use in combination with other meds because resistant strains may rapidly evolve
Inhibits cell protein synthesis hat interferes with viral replication
Blocks protease activity in HIV
✔✔Side Effects of HIV Treatment - ✔✔Assess for opportunistic infection (cancer,
neurological disease)
Headache
Fatigue
,Nausea
Vomiting
Diarrhea
Abdominal discomfort
Anemia
Taste Perversion
Asthenia
Circumoral Parestehsia with ritonivair
✔✔Adverse Reactions/Toxicity with HIV Therapy - ✔✔Hepatotoxicity: AST, ALT,
bilirubin
- N/V, jaunidce, upper right quadrant enlargement and tenderness
- Reduce dose with liver dysfunction
Nephrotoxicity: creatine, BUN, creatinine clearance, urinalysis
- Keep accurate I/O
- Monitor for SE off neutropenia
- Observe signs of occult infection - lower back, flank, suprapubic pain; normal temp or
low-grade fever r/t UTI
✔✔When to Start HIV Therapy - ✔✔1. All symptomatic HIV people (presenting with a
AIDS-defining illness)
2. CD4 count <350 mm^3
3. Pregnant women (AZT is used to prevent maternal transmission of HIV)
STOP if severe rash or other HS reaction occurs
Treatment will be long-term
✔✔Teaching for HIV Therapy - ✔✔Use neutropenic precautions
Eat small frequent meals with complete or complementary proteins
✔✔Positive Inotropic Meds - ✔✔Increase cardiac contractility
Ex: epinephrine, norepinephrine, dopamine
✔✔Negative Inotropic Meds - ✔✔Decrease cardiac contractility, lower BP
Ex: quinidine, beta blockers
✔✔Sulfonamides - ✔✔Anti-infective
Bacteriostatic
Action on bacteria results from interference with the functioning of enzyme systems
necessary for normal metabolism, growth, and multiplication
Treats: UTI, Chlamydia causing blindness, pneumonia, brain abscess, ulcerative colitis,
active Crohn's Disease, Rheumatoid Arthritis
Ex: Bactrim
,✔✔Side Effects of Sulfonamides - ✔✔Rash common - most are utricaria and
maculopapular
GI symptoms
Bone marrow depression
HA
Dizziness/vertigo
Ataxia
Convulsion
Depression
✔✔Adverse Effects/Toxicity of Sulfonamides - ✔✔Hepatotoxicity
Nephrotoxicity
Stevens Johnson Syndrome
✔✔Cautions with Sulfonamides - ✔✔Do not use if:
- Known allergies to sulfa drugs
- In polyuria, advanced renal or hepatic dysfunction
- With intestinal and urinary blockage
- Asthma
Adequate fluid intake (3,00-4,000 mL/day) to promote urinary output, at least 1,500
mL/d to prevent crystalluria/stone formation
May be taken after meals to prolong time in intestine
Collect C/S prior to beginning therapy
✔✔Thiazdie Diuretics - ✔✔Ex: Chlorothiazide (Hydrodiruil), Hydrochlorothiazide (HCTZ,
Diuril)
Ends in -ZIDE
Non-potassium sparing diuretic
Acts on distal tubes, blocks reabsorption of sodium, chloride, and water. Leads to
increased loss of potassium
Use for edema and mild to moderate HTN
Will see effect within 1-4 weeks
✔✔Side Effects with Thiazide Diuretics - ✔✔Dizziness, vertigo, HA, weakness,
dehydration, orhtostatic hypotension
N//V, abdominal pain, diarrhea, constipation, frequent urination
Dermatitis and rash
Electrolyte imbalance
Impaired glucose tolerance
✔✔Adverse Effects/Toxicity of Thiazide Diuretics - ✔✔Renal Failure
Aplastic anemia
Agranulocytosis
Thrombocytopenia
Anaphylactic reaction
, ✔✔Cautions with Thiazdie Diuretics - ✔✔Take early in the day to avoid nocturia
Take with food to avoid GI upset
Thiazide is ineffective if creatinine clearance is <30 mL/min
Eat foods high in K+
Restrict sodium - do not use salt substitute if taking K+-supplement
Weigh self daily and report sudden weight gains or losses
Avoid use with children and anuria
✔✔Tricyclic Antidepressants - ✔✔initial mechanism takes 1-3 weeks to develop
Maximum response is achieved in 6-8 weeks
Long half-life
Most end in -INE
- Nortyrptyine (Pamelor)
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Impipramine (Tofranil)
Blocks the reuptake of NE or 5HTs or both, leaving more available in the CNS. It
intensifies the effect of NE and 5HT which can elevate mood, increase activity and
alertness, decrease preoccupation with morbidity, improve appetite and regulate sleep
pattern
It is used to treat insomnia, attention deficit/hyperactivity and panic disorder
Take it at night - causes sedation
Do not take with MAO - causes hypertensive crisis from excessive adrenergic
stimulation of heart and blood vessels
Monitor orthostatic BP of patient in hospital
✔✔Side Effects of Tricyclic Antidepressants - ✔✔Orthostatic Hypotension
Sedation and anticholinergic effects
✔✔Adverse Effects/Toxicity of Tricyclic Antidepressants - ✔✔Most serious = cardiac
toxicity
in absence of overdose or preexisting cardiac impairment, serious cardiac impairment is
rare
Urinary retention is urgent
OD can cause convulsions
✔✔Cautions with Tricyclic Antidepressants - ✔✔Use with caution...Glaucoma, elderly,
constipation, prostatic hyperplasia (more sensitive to anticholinergic effect)
Avoid use with: hypersensitivity, MI, CV disease
✔✔Hepatitis - ✔✔Inflammation of the liver caused by virus, bacteria or exposure to
meds or hepatotoxins
