ATI PHARMACOLOGY PROCTORED EXAM
VERSION 1
1. A nurse is assessing a client who has a new prescription for chlorpromazine to treat
schizophrenia. The client has a mask-like facial expression and is experiencing involuntary
movements and tremors. Which of the following medications should the nurse anticipate
administering?
1. Amantadine.
2. Bupropion
3. Phenelzine
4. Hydroxyzine
Answer: 1. Amantadine.
2. A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to
promote sleep. The nurse should plan to monitor the client for which of the following adverse
effects?
1. ecchymosis
2. decrease urine output.
3. increase blood pressure.
4. dizziness
Answer: 4. dizziness
3. A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult
client who has Paget's disease of the bone. Which of the following actions should be the nurse's
priority?
1. Administer the medication to the client before breakfast in the morning.
2. Ambulate the client to a chair prior to administering the medication.
3. Give the medication to the client with water rather than milk.
4. Teach the client how to take the medication at home.
Answer: 2. Ambulate the client to a chair prior to administering the medication.
4. A nurse is caring for a client who has a new prescription for ergotamine. The nurse should
recognize that ergotamine is administered to treat which of the following conditions?
1. Raynaud's phenomenon
2. Migraine headaches
3. Ulcerative colitis
4. Anaemia
Answer: 2. Migraine headaches
5. A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the
following findings indicates that the client is experiencing an adverse effect of this medication?
1. Hypoglycemia
2. Proteinuria
3. Nasal congestion
4. Visual disturbances
Answer: 2. Proteinuria
6. A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose.
The nurse should instruct the client that lactulose has which of the following therapeutic effects?
1. Increases blood pressure
2. Prevents esophageal bleeding
3. Decreases heart rate
4. Reduces ammonia levels
Answer: 4. Reduces ammonia levels
7. A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse
should include in the teaching that which of the following conditions is a contraindication to this
medication?
1. Hyperthyroidism
2. Intestinal obstruction
3. Glaucoma
4. Low blood pressure
Answer: 2. Intestinal obstruction
8. A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse
should include a severe allergy to which of the following medications is a contraindication to
ceftriaxone?
1. Gentamicin
2. Clindamycin
3. Piperacillin
4. Sulfamethoxazole-trimethoprim
Answer: 3. Piperacillin
9. A nurse is administering subcutaneous heparin to a client who is at risk for deep vein
thrombosis. Which of the following actions should the nurse take?
1. Administer the medication into the client's abdomen.
2. Inject the medication into a muscle.
3. Massage the site after administering the medication.
4. Use a 22-gauge needle to administer the medication.
Answer: 1. Administer the medication into the client's abdomen.
10. A nurse is providing teaching to a client who has a urinary tract infection and new
prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the
client indicates the need for further teaching?
1. "If the phenazopyridine upsets my stomach, I can take it with meals."
2. "The phenazopyridine will relieve my discomfort, but the ciprofloxacin will get rid of the
infection."
3. "I need to drink 2 Liters of fluid per day while I am taking the ciprofloxacin."
4. "I should notify my provider immediately if my urine turns an orange colon."
Answer: 4. "I should notify my provider immediately if my urine turns an orange colour."
11. A nurse is providing teaching to a group of new parents about medications. The nurse should
include that aspirin is contraindicated for children who have a viral infection due to the risk of
developing which of the following adverse effects?
1. Reye's syndrome
2. Visual disturbances
3. Diabetes mellitus
4. Wilms' tumour
Answer: 1. Reye's syndrome
12. A nurse is preparing to administer lactated Ringer's (LR) 1,000 mL IV to infuse over 8 hr. The
drop factor or the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to
deliver how may gtt/min? (Round the answer to the nearest whole number).
Answer:
1 hr/60 min = 8 hr/X min
X = 480 min
1,000 mL/480 min x 10 gtt/mL = X gtt/min
X = 20.833 21 gtt/ min
13. A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should
recognize that tamoxifen has which of the following therapeutic effects?
1. Antiestrogenic
2. Antimicrobial
3. Androgenic
4. Anti-inflammatory
Answer: A. Antiestrogenic
14. A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses
daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round
the answer to the nearest whole number)
Answer: 2.2 lb/1 kg = 22 lb/X kg
X = 10 kg
4 mg x 10 kg = 40 mg/day
20mg
15. A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the
following findings indicates that the client is experiencing an adverse effect of this medication?
1. Hypoglycaemia
2. Proteinuria
3. Nasal congestion
4. Visual disturbances
Answer: 2. Proteinuria
16. A nurse is providing teaching to a client who has cirrhosis and a new prescription for
lactulose. The nurse should instruct the client that lactulose has which of the following
therapeutic effects?
1. Increases blood pressure
2. Prevents esophageal bleeding
3. Decreases heart rate
4. Reduces ammonia levels
Answer: 4. Reduces ammonia levels
17. A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse
should include in the teaching that which of the following conditions is a contraindication to this
medication?
1. Hyperthyroidism
2. Intestinal obstruction
3. Glaucoma
4. Low blood pressure
Answer: 2. Intestinal obstruction
18. A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse
should include a severe allergy to which of the following medications is a contraindication to
ceftriaxone?
1. Gentamicin
2. Clindamycin
3. Piperacillin
4. Sulfamethoxazole-trimethoprim
Answer: 3. Piperacillin
19. A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking
tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of
the following adverse effects?
1. Allergic response
2. Superinfection
3. Renal toxicity
4. Hepatotoxicity
Answer: 2. Superinfection
20. A nurse is reviewing the laboratory values for a client who is receiving a continuous IV
heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse
prepare to take?
1. Administer vitamin K
2. Reduce the infusion rate
3. Give the client a low-dose aspirin
4. Request an INR
Answer: 2. Reduce the infusion rate
21. Final practice a nurse is planning to administer diltiazem via IV bolus to a client who has
atrial fibrillation. When assessing the client, the nurse should recognize that which of the
following findings is a contraindication to administration of diltiazem?
1. hypotension
2. tachycardia
3. decreased level of consciousness
4. history of diuretic use
Answer: 1. hypotension
22. A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure.
Which of the following data should the nurse plan to review prior to administration of this
medication?
1. blood pressure
2. temperature
3. blood glucose levels
4. total protein levels
Answer: 1. blood pressure
23. A nurse is providing discharge teaching to a client who has heart failure and a new
prescription for digoxin 0.215 mg PO daily and furosemide 20 mg PO daily. Which of the
following statements by the client indicates an understanding of the teaching?
1. "I know that blurred vision is something I will expect to happen while taking digoxin."
2. "I will measure my urine output each day and document it in my diary."
3. "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute."
4. "I will eat fruits and vegetables that have high potassium content every day."
Answer: 4. "I will eat fruits and vegetables that have high potassium content every day."
24. A nurse is preparing to administer iron dextran IV to a client. Which of the following actions
should the nurse plan to take?
1. administer a small test dose before giving the full dose
2. infuse the medication over 30 seconds
3. monitor client closely for hypertension
4. administer cyanocobalamin as an antidote if toxicity occurs
Answer: 1. administer a small test dose before giving the full dose
25. A nurse is assessing a client who has a new prescription for chlorpromazine to treat
schizophrenia. The client has a mask-like facial expression and is experiencing involuntary
movements and tremors. Which of the following medications should the nurse anticipate
administering?
1. Amantadine.
2. Bupropion
3. Phenelzine
4. Hydroxyzine
Answer: 1. Amantadine.
26. A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to
promote sleep. The nurse should plan to monitor the client for which of the following adverse
effects?
1. ecchymosis
2. decrease urine output.
3. increase blood pressure.
4. dizziness
Answer: 4. dizziness
27. A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult
client who has Paget's disease of the bone. Which of the following actions should be the nurse's
priority?
1. Administer the medication to the client before breakfast in the morning.
2. Ambulate the client to a chair prior to administering the medication.
3. Give the medication to the client with water rather than milk.
4. Teach the client how to take the medication at home.
Answer: 2. Ambulate the client to a chair prior to administering the medication.
28. A nurse is caring for a client who has a new prescription for ergotamine. The nurse should
recognize that ergotamine is administered to treat which of the following conditions?
1. Raynaud's phenomenon
2. Migraine headaches
3. Ulcerative colitis
4. Anemia
Answer: 2. Migraine headaches
29. A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which of
the following medications should the nurse plan to administer?
1. Ibuprofen
2. Naproxen
3. Aspirin
4. Acetaminophen
Answer: 4. Acetaminophen
30. A nurse is providing teaching to a parent of a child who has asthma and a new prescription for
a cromolyn sodium metered dose inhaler. Which of the following statements by the parent
indicates the need for further teaching?
1. "I will give my child a dose as soon as wheezing starts."
2. “My child should rinse out his mouth after using the inhaler.”
3. "My child should exhale completely before placing the inhaler in his mouth."
4. "If my child has difficulty breathing in the dose, a spacer can be used."
Answer: 1. "I will give my child a dose as soon as wheezing starts."
31. A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance.
The client has an increased thyroid stimulating hormone (TSH) level and a decreased total T3 and
T4 level. The nurse should anticipate a prescription for which of the following medications?
1. Methimazole
2. Somatropin
3. Levothyroxine
4. Propylthiouracil
Answer: 3. Levothyroxine
32. A nurse is planning care for a client who has a seizure disorder and a new prescription for
valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select
all that apply)
1. PTT
2. Asparate aminotransferase (AST)
3. Alanine aminotransferase (ALT)
Answer: 1. PTT
2. Asparate aminotransferase (AST)
3. Alanine aminotransferase (ALT)
33. A nurse is providing teaching to a client who has a new prescription for hydrochlorothiazide
50 mg PO daily to treat hypertension. Which of the following instructions should the nurse
include in the teaching?
1. "Take hydrochlorothiazide as needed for edema."
2. “Check your weight once each week.”
3. "Take the hydrochlorothiazide on an empty stomach."
4. "Take the hydrochlorothiazide in the morning."
Answer: 4. "Take the hydrochlorothiazide in the morning."
34. A nurse is preparing to administer amoxicillin 250 mg liquid suspension PO every 8 hr to an
older adult client. The amount available is amoxicillin 50 mg/mL. How many mL should the
nurse administer per dose? (Round the answer to the nearest whole number)
Answer:
50 mg/1 mL = 250 mg/X mL 250/ 50 = 5
X = 5 mL
35. A nurse is providing teaching to a client who has gout and a new prescription for allopurinol.
The nurse should instruct the client to discontinue taking the medication for which of the
following adverse effects?
1. Nausea
2. Metallic taste
3. Fever
4. Drowsiness
Answer: 3. Fever
36. A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for
sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse
effects of this medication?
1. Jaundice
2. Constipation
3. Oral candidiasis
4. Sedation
Answer: 1. Jaundice
37. A nurse is providing teaching to a client who has rheumatoid arthritis and a prescription for
long term prednisone therapy. the nurse should instruct the client to monitor for which of the
following adverse effects?
1. Stress fractures
2. Orthostatic hypotension
3. Gingival ulcerations
4. Weight loss
Answer: 1. Stress fractures
38. Nurse is preparing to administer heparin 8,000 units subcutaneously every eight hrs. The
amount available is heparin injection 10,000 units/mL. How many milliliters should the nurse
administer per dose? (Round the answer to the nearest tenth)
Answer:
8000/10000 = 0.8 mL
39. A nurse is caring for a client who has a new prescription for enalapril. The nurse should
monitor the client for which of the following adverse effects of this medication?
1. Ecchymosis
2. Jaundice
3. Hypotension
4. Hypokalaemia
Answer: 3. Hypotension
40. A nurse is caring for a client who is at 28 weeks of gestation and is experiencing preterm
labor. Which of the following medications should the nurse plan to administer?
1. Oxytocin
2. Nifedipine
3. Dinoprostone
4. Misoprostol
Answer: 2. Nifedipine
41. A nurse is caring for a client who has a new prescription for amphotericin B. The nurse
should plan to monitor the client for which of the following adverse effects?
1. Hyperkalemia
2. Hypertension
3. Constipation
4. Nephrotoxicity
Answer: 4. Nephrotoxicity
42. A nurse is administering subcutaneous epinephrine for a client who is experiencing
anaphylaxis. The nurse should monitor the client for which of the following adverse effects?
1. Hypotension
2. Hyperthermia
3. Hypoglycemia
4. Tachycardia
Answer: 4. Tachycardia
43. A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor
the client for which of the following adverse effects?
1. Insomnia
2. Hypotension
3. Bleeding
4. Constipation
Answer: 3. Bleeding
44. A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat
depression. Which of the following diagnostic tests should the nurse plan to perform prior to
starting the client on this medication?
1. Hearing examination
2. Glucose tolerance test
3. Electrocardiogram
4. Pulmonary function tests
Answer: 3. Electrocardiogram
45. A nurse is providing teaching to a client who has chronic kidney failure which an AV fistula
for haemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic
effects of epoetin alfa should the nurse include in the teaching?
1. Reduces blood pressure
2. Inhibits clotting of fistula
3. Promotes RBC production
4. Stimulates growth of neutrophils
Answer: 3. Promotes RBC production
46. A nurse is preparing to administer an enteral tube feeding through an NG tube at 250 mL over
4 hr. The nurse should set the pump to deliver how many mL/hr? (Round the answer to the
nearest whole number)
Answer:
250 mL/4 hr = X mL/hr
X = 62.5 63mL/hr
47. A nurse is providing teaching to a newly licensed nurse about caring for a client who has a
prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which
of the following laboratory tests?
1. Platelet count
2. Electrolyte levels
3. Thyroid function
4. Liver function
Answer: 4. Liver function
48. A nurse is caring for a client who has been taking isoniazid and rifampin for 3 weeks for the
treatment of active pulmonary tuberculosis (TB). The client reports his urine is an orange color.
Which of the following statements should the nurse make?
1. "Stop taking the isoniazid for 3 days and the discoloration should go away."
2. "Rifampin can turn body fluids orange."
3. "I'll make an appointment for you to see the provider this afternoon."
4. Isoniazid can cause bladder irritation."
Answer: 2. "Rifampin can turn body fluids orange."
49. A nurse is preparing to administer prochlorperazine 2.5 mg IV. Available is prochlorperazine
injection 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest
tenth)
Answer:
5 mg/1 mL = 2.5 mg/X mL
X = 0.5
50. A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim.
The nurse should recognize that an increase in which of the following values indicates a
therapeutic effect of this medication?
1. Erythrocyte count
2. Neutrophil count
3. Lymphocyte count
4. Thrombocyte count
Answer: 2. Neutrophil count
51. A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension.
The nurse should plan to monitor the client for which of the following adverse effects?
1. Thrombophlebitis
2. Hyperactive reflexes
3. Muscle weakness
4. Hypoglycemia
Answer: 3. Muscle weakness
52. A nurse is providing teaching to a newly licensed nurse about administering morphine via IV
bolus to a client. Which of the following information should the nurse include in the teaching?
1. Respiratory depression can occur 7 min after the morphine is administered.
2. The morphine will peak in 10 min.
3. Withhold the morphine if the client has a respiratory rate less than 16/min.
4. Administer the morphine over 2 min.
Answer: 1. Respiratory depression can occur 7 min after the morphine is administered.
53. A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent
client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin
at which of the following times?
Answer: Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the
onset of action around 0745 and ensure the client eats breakfast immediately following
administration of the insulin.
Onset of action: 0745
54. A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40mg daily
but the client reports she has been taking extra doses to promote weight loss. Which of the
following indicates she is dehydrated?
Answer: urine specific gravity of 1.035
Oliguria, increased urine concentration, and an increase in urine specific gravity greater than
1.030 are expected findings in clients who are dehydrated.
55. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and
administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide
oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose/ (Round to
the nearest tenth)
Answer:
2.6 mL
2.2 lb/1 kg = 28.6 lb/X kg
X = 13 kg 20 mg x 13 kg = 260 mg/day
250 mg/5 mL = 130 mg/X mL
X = 2.6 mL
56. A nurse is preparing a discharge teaching plan for a client who is to begin long-term oral
prednisone for asthma. Which of the following instructions should the nurse include in the plan?
1. Stop taking the medication if a rash occurs.
2. Take the medication on an empty stomach to enhance absorption.
3. Schedule the medication on alternate days to decrease adverse effects.
4. Treat shortness of breath with an extra dose of the medication.
Answer: 3. Schedule the medication on alternate days to decrease adverse effects.
57. A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe
urinary tract infection (UTI). The client asks why both medications are needed. Which of the
following responses should the nurse make?
1. "Phenazopyridine decreases adverse effects of ciprofloxacin hydrochloride."
2. "Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy."
3. "The use of phenazopyridine allows for a lower dosage of ciprofloxacin hydrochloride."
4. "Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain."
Answer: 4. "Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats
pain."
58. A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water (D5W)
to infuse over 15 min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set
the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number)
Answer:
10 gtt/1 mL x 50 mL/15 min = X gtt/min
X = 33.3333 33 gtt/min
59. A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client
reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take
first?
1. Encourage the client to eat the toast on the breakfast tray.
2. Administer an antiemetic.
3. Inform the client's provider.
4. Check the client's apical pulse.
Answer: 4. Check the client's apical pulse.
VERSION 2
Pharmacology ATI
1. A nurse is assessing a client who is receiving chloramphenicol (Chloromycetin). Which of the
following findings is an adverse effect of this medication? (adverse affect is thrombocytopenia)
1. Ecchymos
2. to toxicity
3. Hypertension
4. Anxiety
Answer: 3. Hypertension
2. A nurse is caring for a client who is to receive 1,500 mL of 0.9% sodium chloride IV over 8
hours. The nurse plans to use IV tubing with a drop factor of 10 gtt/mL. How many gtt/min of IV
fluid should the client receive? (Round your answer to the nearest whole number).
Answer:31 gtt/min
3. A nurse is admitting a client to a long-term care facility. While reconciling the medication
prescribed at home with those prescribed in the facility, the nurse discovers a discrepancy in the
dosages. Which action should the nurse take?
1. Clarify the medication dosages with the provider.
2. Change the prescribed medication dosages to reconcile the discrepancy
3. Contact the pharmacist regarding the dosage discrepancies
4. Ask a family member to verify the medication dosages
Answer: 1. Clarify the medication dosages with the provider.
4. A nurse is caring for a client who is receiving a fentanyl transdermal system (Duragesic). What
is important to document in the client’s record?
1. Fluid intake
2. Skin integrity
3. Respiratory rate
4. Pulse rate
Answer: 3. Respiratory rate
5. A nurse is caring for a client who has acute angina and has a prescription for nitroglycerin.
Which of the following is an appropriate intervention for the nurse to take when administering
this medication?
1. Massage the nitro-glycerine ointment completely into the skin.
2. Replace the nitro-glycerine transdermal patch every 4 hours.
3. Administer a sustained nitro-glycerine tablet orally.
4 Administer a nitro-glycerine tablet sublingually every 5 minutes.
Answer: 4 Administer a nitro-glycerine tablet sublingually every 5 minutes.
6. A nurse is preparing to administer infliximab (Remicade) to a client who has rheumatoid
arthritis. The nurse should watch the patient for which of the following adverse effects? (Select
all that apply.)
1. Bradycardia
2. Jaundice
3. Polyuria
4. Urtipenia
5. Fever
Answer: 2. Jaundice
4. Urtipenia
5. Fever
7. A nurse is providing teaching to a client who was recently diagnosed as HIV positive. The
client is beginning medication therapy with zidovudine (Retrovir). Which of the following
statements should the nurse include in the teaching. (Select all that apply.)
1. Must be taken with other retroviral medicines.
2. Has few adverse effects
3. Cures an HIV infection
4. Prevents you from transmitting the HIV infection
5. Increases CD4+ cell count
Answer: 1. Must be taken with other retroviral medicines.
2. Has few adverse effects
5. Increases CD4+ cell count
8. A nurse is assessing a school age client who is experiencing seizure activity and is prescribed
diazepam (Valium) IV. The nurse should should clarify the order if the client is receiving a
continuous infusion of which of the following IV:
1. Lactated Ringers solution
2. 0.9% Sodium chloride with 100 units of regular insulin
3. 0.9% sodium chloride
4. 0.9% Sodium chloride with 20 mEq of potassium chloride
Answer: 1. Lactated Ringers solution
9. A nurse is assessing a client who is taking enalapril (Vasotec) for congestive heart failure.
Which of the following indicates an expected finding?
1. Activity tolerance
2. Orthostatic hypotension
3. Loss of strength
4. Increase in blood pressure
Answer: 2. Orthostatic hypotension
10. A child with cerebral palsy is prescribed Baclofen (Lioresol). Which of the following
therapeutic effects should the nurse monitor?
1. Increased urine output
2. Increased energy
3. Decreased anxiety
4. Decreased spacity
Answer: 4. Decreased spacity
11. Clinical findings of a client who has a prescription for lithium carbonate (Lithobid). For
which reasons should the nurse withhold the medication and notify the provider?
1. Lithium level 1.0 mEq/L
2. Potassium at 3.7 mEq/L
3. Sodium at 143 mEq/L
4. Lithium level 2.5 mEq/L
Answer: 4. Lithium level 2.5 mEq/L
12. The nurse is caring for a client who has tuberculosis and is being treated with combination
medication therapy. To test the effectiveness of the treatment, the nurse should periodically
monitor which of the following laboratory results.
1. TT
2. ESD rate
3. Sputum culture
4. INR
Answer: 2. ESD rate
13. A nurse is caring for a client who is taking amoxicillin (Amoxil) and is experiencing adverse
effects. Which of the following instructions should the nurse give to this client?
1. “Stand up slowly after taking this medication.”
2. “Monitor for increased urine output.”
3. “Take this medication with a snack.”
4. “Administer the medication at bedtime.”
Answer: 2. “Monitor for increased urine output.”
14. A nurse is reviewing the medication administration record for a client who has metastatic
cancer and a fentanyl (Duragesic) transdermal patch for pain. The client reports a pain level of 10
on a scale of 0 to 10. Which of the following medications should the nurse anticipate
administering?
1. Hydromorphone (Dilaudid)
2. Butorphanol (Stadol)
3. Alprazolam (Xanax)
4. Carbenezepine (Tegretol)
Answer: 1. Hydromorphone (Dilaudid)
15. A nurse is caring for a client with PCA Morphine Sulfate. Which of the following statements
is not true?
1. "I will not receive any pain medications during the lockout period"
2. "I should push the button when the pain becomes severe"
3. "I will be asked to rate my pain occasionally"
4. "I don't have to worry about getting an overdose of the medication"
Answer: 4. "I don't have to worry about getting an overdose of the medication"
16. A nurse is caring for a client who is to receive a series of allergy tests. The nurse should
instruct the client to avoid which medications for up to 4 weeks before the procedure?
1. Acetemetaphen (Tylenol)
2. Diphenhyramine (Benadryl)
3. Albuterol (Accuneb)
4. Psuedoephedrine hydrochloride (Sudafed)
Answer: 2. Diphenhyramine (Benadryl)
17. A nurse administered meperidine (Demerol) intramuscularly to a client with an ankle fracture.
Which of the following actions should the nurse take next?
1. Assess the client’s respirator y status
2. Document on the clients medication record
3. Reassess the client's pain level
4. Check the client's blood pressure
Answer: 1. Assess the client’s respirator y status
18. A nurse is caring for a client who has an order for clozapine (Clozaril) 350 mg PO daily. The
nurse should recognize that which of the following findings is a side effect of this medication?
1. WBC 8,000 mm3
2. Serum sodium 136 mg/dL
3. Fasting blood glucose of 220 mg/dL
4. Weight loss of 2.26 kg (5 lb) in 2 weeks
Answer: 1. WBC 8,000 mm3
19. A client with diabetes mellitus is admitted to the medical unit. The client has routine beforebreakfast prescription for 8 units of regular insulin and 18 units of NPH. The primary care
provider adds an additional dose of Regular insulin based on the following:
Blood Glucose Regular Insulin
Dose 121 to 150 2 units
151 to 180 4 units
201. 200 6 units
201 to 250 8 units
> 250 Call provider
The client’s pre-breakfast glucose is 192 mg/dl. Which dosage of insulin should the nurse
administer?
1. 8 units of Regular, 18 units of NPH
2. 8 units of Regular, 24 units of NPH
3. 14 units of Regular, 18 units of NPH
4. 14 units of Regular, 24 units of NPH
Answer: 2. 8 units of Regular, 24 units of NPH
20. A nurse is caring for a client who has a new prescription of zolpidem (Ambien) 10 mg by
mouth. Which comments by the client indicates understanding regarding this medication?
1.“ I will take my medication at bedtime.”
2. “I will take this medication with food.”
3. “I will stop taking this medication in 1 week, so I don’t get addicted.”
4 “I will take vitamin C to increase the effectiveness of this medication.”
Answer: 1.“ I will take my medication at bedtime.”
21. A nurse is monitoring a client who is taking fosinopril (Monopril). The nurse should
understand that this has a beneficial effect on which of the body systems?
1. Gastrointestinal
2. Cardiovascular
3. Pulmonary
4. Reproductive
Answer: 2. Cardiovascular
22. A nurse is assessing a client who is taking naproxen (Naprosyn). Which of the following is an
expected outcome for this client?
1. Increased appetite
2. Reduced bleeding
3. Improved breathing
4. Reduced pain
Answer: 4. Reduced pain
23. A nurse is providing teaching to a client who just started taking lithium (Eskalith). Which of
the following statements indicates that the client understands the teaching?
1. ‘I should inject this medication subcutaneously.’
2. “I should expect to feel better in just a few days.”
3. “ I should call my doctor if I develop hand tremors.”
4. “I should take this medication on an empty stomach.”
Answer: 3. “ I should call my doctor if I develop hand tremors.”
24. A nurse is administering verapamil (Calan) to a client via IV bolus. The nurse should monitor
for which outcome?
1. A rapid increase in aPTT.
2. A sudden increase in heart rate.
3. A sudden decrease in heart rate.
4. A rapid decrease of aPTT.
Answer: 3. A sudden decrease in heart rate.
25. A nurse is caring for a client who has rheumatoid arthritits. The client is prescribed
methotrexate (Rheumatrex). Which of the following should the nurse instruct the client to
monitor and report to the provider?
1. Sore throat
2. Urinary retention
3. Constipation
4. Insomnia
Answer: 1. Sore throat
26. A nurse is caring for a client who has been prescribed Ceftriaxone (Rocephin). The nurse
notes that the client’s chart lists a penicillin allergy. Which of the following actions should the
nurse take first?
1. Notify the provider that the client is allergic to the medication.
2. Teach the client about signs of allergic response.
3. Question the client about previous allergic reactions.
4. Administer the medication and monitor the client for allergic response.
Answer: 4. Administer the medication and monitor the client for allergic response.
27. A nurse is teaching a client who has decided to quit smoking about using a nicotine
transdermal system (Nicotrol). Which of the following instructions should the nurse include?
1. Cleanse the skin with alcohol before applying the patch.
2. Moisten the patch and hold it against the skin until it adheres.
3. Apply the patch first thing in the morning and remove it at bedtime.
4. Place the patch in the same skin area for the duration of the treatment.
Answer: 3. Apply the patch first thing in the morning and remove it at bedtime.
28. A nurse is caring for a client who has been taking furosemide (Lasix) for 3 days to treat heart
failure. Which of the following findings indicate that the medication is effective?
1. Reduced levels of HDL
2. Potassium within the expected reference range
3. Clear lung sounds
4. Increased level of consciousness
Answer: 2. Potassium within the expected reference range
29. A client is questioning the nurse about why she is receiving frequent doses of IV antibiotics.
Which of the following responses by the nurse is appropriate?
1. It helps to maintain a steady drug level
2. It helps to prevent the emergence of drug-resistant bacteria
3. It decreases the risk of an allergic reaction
4. It decreases the length of necessary treatment
Answer: 2. It helps to prevent the emergence of drug-resistant bacteria
30. A female adult client is scheduled to start a prescription for azathioprine (Imuran) for active
Rheumatoid Arthritis. The nurse should inform the client about the need for which of the
following diagnostic tests prior medication?
1. Erythrosedimentation rate
2. Bone density scan
3. Electrocardiogram
4. Pregnancy Test
Answer: 1. Erythrosedimentation rate
31. A nurse is caring for a client who has been taking ferrous sulfate for the past 2 months. Which
of the following findings is expected?
1. Increased energy
2. Reduced frequency of coughing
3. Increased vision
4 Decreased inflammation
Answer: 1. Increased energy
32. A nurse is caring for a client who has a prescription for Metformin (Glucophage) twice daily.
Which of the following lab results projects the expected outcome?
1. Hemoglobin A1C 6.4%
2. Pre-meal plasma glucose 135mg/dl
3. Bedtime blood glucose 150 mg/dl
4. Systolic blood pressure 146 mm Hg
Answer: 1. Hemoglobin A1C 6.4%
33. A nurse is teaching about IV betamethasone (Celestone Soluspan) with a client who is at 31
weeks of gestation and is in premature labor. Which of the following information should the
nurse include in the teaching?
1. Prevents contractions of the uterus to avoid premature birth
2. Promotes the production of surfactant in the fetal lung
3. Decreases inflammation associated with an allergic reaction
4. Suppresses the immune system to prevent fetal respiratory distress.
Answer: 2. Promotes the production of surfactant in the fetal lung
34. A nurse is providing teaching to a client who had a total gastrectomy. The client has a new
prescription for Cyanocobalamin (Vitamin B12). Which of the following client statements
indicates understanding of the teaching?
1. “ I will have to take this medication for the rest o f m y life. ”
2. “After I receive injections for a week, I will be able to switch to a pill.”
3. “I need to have my vitamin B12 levels measured once a month.”
4. “Increasing my intake of green, leafy vegetables will increase my vitamin B12 levels.”
Answer: 1. “ I will have to take this medication for the rest o f m y life. ”
35. A nurse is planning teaching for a client who has leukemia and is receiving chemotherapy.
The client is taking Allopurinal (Zyloprim). The nurse should instruct the client that this
medication will?
1. Decrease blood glucose levels
2. Prevent cardiac toxicity.
3. Prevent urinary tract infections.
4. Decrease uric acid levels.
Answer: 4. Decrease uric acid levels.
36. A nurse receives a phone call from a client who has heart failure and reports a dry cough for
the last week. After reviewing the client’s medical record, the nurse asks the client to come to the
provider’s office. The nurse should then instruct the client to stop taking which of the following
daily medications until he sees his provider?
1. Isosorbide (Imdur)
2. Hydroclorothiazide (Hydrodiuril)
3. Nifedipine (Procardia)
4. Lisinopril (Zestril)
Answer: 2. Hydroclorothiazide (Hydrodiuril)
37. A nurse is planning discharge teaching for a client who is to start therapy with repaglinide
(Prandin). Which of the following should the nurse include in the teaching?
1. “Take the medication 1 hour before mealtime.”
2. “Hold the medication if your blood glucose is less than 120 mg/d L.”
3. “Monitor for irritability and diaphoresis.”
4. “Increase your protein intake.”
Answer: 2. “Hold the medication if your blood glucose is less than 120 mg/d L.”
38. A nurse is caring for a client who is receiving anticoagulant therapy with Warfarin
(Coumadin). The client is prescribed Cefotetan (Cefotan) by intermittent IV bolus for pneumonia.
The nurse should monitor the client for which of the following?
1. Hemorrhage
2. Hypoglycemia
3. Hyperkalemia
4. Paresthesias
Answer: 3. Hyperkalemia
39. A nurse is assessing a client who has been taking anti-tuberculosis medications for the past 3
months. The nurse should instruct the client to notify the provider if which of the following
occurs?
1. Weight gain
2. Jaundice
3. Alopecia
4. Polyuria
Answer: 2. Jaundice
40. A client who has supraventricular tachycardia (SVT) is receiving procainamide. The nurse
recognizes that the primary pharmacological action of this medication is to:
1. Decrease cardiac preload
2. Promote systemic vasoconstriction
3. Decrease sinoatrial node conduction.
4. Control the rate of cardiac contraction.
Answer: 3. Decrease sinoatrial node conduction.
41. A client is receiving extended-release morphine sulfate (Avinza) 30mg PO every 12 hr. Three
hours after the last dose, the client requests pain medication. Which of the following assessment
finding is the best indicator of the patient’s need for more pain medication?
1. Facial grimacing
2. Elevated blood pressure
3. Flushed skin
4. Self report
Answer: 1. Facial grimacing
42. A nurse is caring for a client who has a systemic infection. During the infusion of vancomycin
(Vancocin) the client develops a rash and becomes flushed. Which of the following is an
appropriate action for the nurse to take?
1. Document a Penicillin allergy in the client’s chart.
2. Decrease the rate of administration.
3. Obtain a prescription for oral vancomycin.
4. Administer naloxone (Narcan) 1mg IV.
Answer: 1. Document a Penicillin allergy in the client’s chart.
43. A nurse is caring for a client who has open angle glaucoma and was prescribed pilocarpine
(Pilocar) 1 gtt of 3% solution. The nurse should recognize that which of the following findings
indicates the client is developing systemic cholinergic toxicity?
1. Stinging and burning sensation in her eye
2. Hypertension
3. Tachycardia
4. Salivation and sweating
Answer: 4. Salivation and sweating
44. A client who has been taking atenolol (Tenormin) receives a new prescription for nifedipine
(Procardia). For which of the following interactions should the nurse monitor?
1. Tachycardia
2. Hypotension
3. Bleeding
4. Angina
Answer: 2. Hypotension
45. A client has an IV infusion of nitroprusside (Nitropress) at 2 mcg/kg/min. The order reads to
titrate the nitroprusside by 0.5 mcg/kg/min to maintain mean arterial pressure (MAP) to 70 to 110
mm HG. The client has a MAP of 120 mm Hg. The nurse should next titrate the nitroprusside to
which of the following dosages? (Round to the nearest tenth.)
Answer: 2.5 mcg
46. A nurse is reviewing the laboratory tests for a client who had an acute myocardial infarction.
The client is prescribed warfarin (Coumadin) 10mg PO. The nurse notes an INR of 2.6. Which of
the following actions should the nurse take?
1. Give the dose as prescribed.
2. Hold the next dose.
3. Increase the dose by 2.5mg
4. Decrease the dose by 5mg.
Answer: 2. Hold the next dose.
47. A nurse is caring for a client who has a new prescription for estrogenprogestin combination
(Ortho-Novum). Which of the following medications may interact with this medication and
require the use of additional non-hormonal birth control?
1. Thiamine (Vitamin B 1)
2. Dilantin (Phenytoin)
3. Amalodipine (Norvasc)
4. Docusate sodium (colace)
Answer: 3. Amalodipine (Norvasc)
48. A nurse is providing teaching to a school-age child and his parents. The child has a new
prescription for methylphenidate (Concerta). For which of the following adverse effects should
the nurse monitor? (Select all that apply.)
1. Nose bleed
2. Oliguria
3. Weight loss
4. Palpitations
5. Insomnia
Answer: 1. Nose bleed
4. Palpitations
5. Insomnia
49. A nurse is caring for a postoperative client with PCA containing IV morphine. A nurse should
recognize which is the following priority assessment?
1. Hypotension
2. Bradypnea
3. Drowsiness
4. Urticaria
Answer: 3. Drowsiness
50. A nurse is caring for a client who is receiving therapy with the clonidine (Catapres)
transdermal patch. The client reports light-headedness and drowsiness. Which of the following
actions should the nurse take?
1. Administer a prescribed antiemetic
2. Remove the Patch
3. Elevate the head of the bed
4. Measure Blood pressure
Answer: 2. Remove the Patch
51. A nurse is assessing a client who takes diphenoxylate with atropine (Lomotil) for
inflammatory bowel disease. For which of the following should the nurse monitor?
1. Hearing loss
2. Increased oral secretions
3. Bradycardia
4. Urinary retention
Answer: 4. Urinary retention
52. A nurse is caring for a client with Parkinson’s disease. The client is taking carbidopa levadopa
(Sinemet) and reports nausea. Which of the following instructions should the nurse include to
reduce nausea?
1. Give medication 1 hr before meals.
2. Give medication with meals
3. Give medication 1 hr after meals
4. Give medication with high-protein snacks.
Answer: 2. Give medication with meals
53. A nurse is caring for an older adult client who is receiving gentamicin (Garamycin) following
abdominal surgery Which of the following physiological changes is most important for the nurse
to consider when administering this medication?
1. Decreased serum albumin
2. Decreased renal blood flow
3. Increased gastric pH
4. Increased body fat
Answer: 2. Decreased renal blood flow
54. A client has a new prescription for oral nitroglycerin sustained-release capsules once a day.
During the nursing history the client reveals his usual medications. Which of the following
medications should the nurse question at this time?
1. Diazepam (Valium)
2. Lansoprazole (Prevacid)
3. Gemfibrozil (Lopid)
4. Sildenafil (Viagra)
Answer: 1. Diazepam (Valium)
55. The nurse is caring for a client who is receiving muromonab-CD3 (orthoclode OKT3) and is
experiencing fever and 3+ pitting edema in the lower extremities. Which of the following actions
should the nurse take for the client?
1. Administer corticosteroids as prescribed.
2. Obtain a prescription for a WBC count
3. Auscultate the client’s lungs for adventitious sounds
4. Maintain strict fluid intake and output measurements.
Answer: 3. Auscultate the client’s lungs for adventitious sounds
56. A nurse is admitting a client who has chest pain to the emergency department. What
medication should the nurse anticipate administering to reduce cardiac demand?
1. Heparin
2. Pentazocine (Talwin)
3. Morphine
4. Butorphanol (Stadol)
Answer: 3. Morphine
57. A nurse is caring for four older adult clients who are taking digoxin (Lanoxin). Which of the
following clients is at greatest risk for developing digoxin toxicity?
1. A client taking furosemide (Lasix) for edema
2. A client taking allopurinol (Zyloprim) for gout
3. A client taking fluoxetine (Prozac) for depression
4. A client taking pramipexole (Mirapex) for Parkinson’s disease
Answer: 1. A client taking furosemide (Lasix) for edema
58. A nurse is caring for a 4 year old client, who is taking amoxicillin (Amoxil) 50 mg/ kg/day
PO in three divided doses. Which of the following resources should the nurse consult to verify
that the dose is safe for the client?
1. Medication administration record
2. The client’s health history
3. Physician’s desk reference
4. The client’s BMI record
Answer: 1. Medication administration record
3. Physician’s desk reference
59. A nurse is caring for a client who has a new prescription for sucraflate (Carafate). The client
also takes several other medications and herbal supplements. Which of the following requires that
the nurse provide additional teaching for this client?
1. Phentoin (Dilantin)
2. Burpropion (Wellbutrin)
3. Ginko biloba
4. Valerian root
Answer: 4. Valerian root
60. A nurse is caring for a client who has a prescription for levadopa carbidopa (Sinemet-CR).
Which of the following should the nurse recognize as an adverse effect of this medication?
1. Constipation
2. Weight gain
3. Hirsultism
4. Dyskinesia
Answer: 1. Constipation
61. A nurse is caring for a client who has received acetaminophen (Tylenol) 650 mg and
Hydrocodone (Vicodin) 5 mg every 4 hr for the past 24 hr. Which of the following is an
appropriate action for the nurse to take?
1. Complete an incident report
2. Stagger the medications every 2 hr
3. Suggest a time with the pharmacy.
4. Decrease acetaminophen to 325 mg every 4 hr.
Answer: 1. Complete an incident report
62. A nurse is caring for a client who has a new prescription for buproion (Welbutrin). What
should the nurse recognize as a contraindication for the use of this medication?
1. Xerostomia
2. GERD
3. Seizure
4. Bradycardia
Answer: 3. Seizure
63. A nurse is caring for a client with a urinary tract infection. Her past history reveals an allergy
to thiazide diuretics. Which of the following medications is contraindicated?
1. Nitrofurantoin (Macrodantin)
2. Ciprofloxacin (Cipro)
3. Amoxicillin/ clavulanate (Augmentin)
4. Trimethoprim/ sulfamethoxazole (Bactrim)
Answer: 4. Trimethoprim/ sulfamethoxazole (Bactrim)
64. A nurse is providing instruction to four clients regarding medication selfadministration.
Which of the following actions by a client indicates a need for further teaching?
1. Client rolls insulin suspension between his palms
2. Client takes iron supplements at bedtime.
3. Client uses cotton swab to apply antibiotic ointment.
4. Client allows 1 min between puffs when he uses a metered-dose inhaler.
Answer: 2. Client takes iron supplements at bedtime.
65. A nurse is caring for a client who is receiving penicillin by intermittent IV bolus. The client
develops cyanosis and tachycardia. A nurse should administer which of the following medications
first?
1. Epinephrine (Adrenalin)
2. Prednisone (Deltasone)
3. Hydrocortisone sodium succinate (SoluCortef)
4. Isoproterenol (Isuprel)
Answer: 1. Epinephrine (Adrenalin)
66. A nurse is preparing to administer insulin to a client with diabetes mellitus. The client is to
receive insulin aspart (NovoLog) 5 units and NPH insulin (Humulin N) 15 units subcutaneously
in the morning. Which of the following actions should the nurse take first?
1. Inject 5 units of air into the insulin aspart vial.
2. Inject 15 units of air into the NPH insulin vial.
3. Draw up 5 units of insulin aspart from the vial.
4. Draw up 15 units of NPH insulin from the vial.
Answer: 3. Draw up 5 units of insulin aspart from the vial.
67. A nurse is providing care to a client who has heart failure. While verifying the orders with the
medication administration record the nurse notes that the prescription for digoxin (Lanoxin) was
transcribed incorrectly. As a result, the client received an extra dose of the medication yesterday.
Which of the following actions should the nurse take first?
1. Complete an incident report.
2. Notify the charge nurse.
3. Obtain a set of vital signs.
4. Withhold the next dose.
Answer: 2. Notify the charge nurse.
68. A nurse is caring for a client who is receiving haloperidol (Haldol). The nurse should
document which of the following findings are dystonia?
1. Neck spasms
2. Lip smacking
3. Tremors
4. Pacing
Answer: 1. Neck spasms
69. A nurse is completing discharge teaching for a client who has hypertension. The client has a
new prescription for spironolactone (aldactone). Which of the following statements by the client
indicates an understanding of the teaching?
1. “I’ll increase my dietary fiber, because this medication causes constipation.”
2. “ I’m aw are that his medication can cause he art palpitations.”
3. “I’ll take aspirin every day, because it makes this medication more effective.”
4. “I realize that I should use sugar substitutes when taking this medication.”
Answer: 2. “ I’m aw are that his medication can cause he art palpitations.”
70. A nurse is caring for a school age child who has been prescribed diphenhydramine
(Benadryl). Which of the following adverse effects has highest priority?
1. Sedation
2. Dry mucous membranes
3. Ataxia
4. Diarrhoea
Answer: 2. Dry mucous membranes
VERSION 3
ATI PHARMACOLOGY
IMPORTANT LAB VALUES
•
Sodium (Na): 136-145 mEq/L
• Calcium: 9.0-10 mg/dL
• Chloride: 98-106 mEq/L
• Bicarb HCO3: 21-28 mEq/L
• Potassium: 3.5-5.0 mg/L
• Phosphorus PO4 : 3.0-4.5 mg/dL
• Magnesium: 1.3- 2.1 mEq/L
• Cholesterol:
o Total <200mg/dL
o LDL ("bad") 40
o Triglycerides <150mg/dL
• Liver enzymes
o ALT/SGPT 8-20 units/L
o AST/SGOT 5-40 units/L
o ALP 42-128 units/L
o Total protein 6-8 gm/dL
• Pancreatic enzymes
o Amylase 56-90 IU/L
o Lipase 0-110 units/L
o Prothrombin time 0.8-1.2
• Glucose:
Preprandial (fasting) 70-110 mg/dL
Postprandial 70-140 mg/dL
• RBC: Females 4.2-5.4 million/uL; Males 4.7-6.1 million /uL
• WBC: 5000 -10,000
• Iron: Females 60-160 mcg/dL; Males 80-180 mcg/dL
• Platelets: 150,000-450,000
• Hemoglobin (Hgb): Females 12-16 g/dL; Males 14-18 g/dL
• Hematocrit (Hct): Females 37-47%;Males 42-52%
• Prothrombin Time (PT): 11-14 seconds: therapeutic range 1.5-2x normal or control value
• Urine specific gravity: 1.015-1.030
• Urine pH: average 6.0; range 4.6-8.0
• BUN: 10-20 mg/dL
• Creatinine: female 0.5-1.1, males 0.6 - 1.2 mg/dL;
• Creatinine phosphokinase MB (CK-MB): normal 30-170 units/L
•
*increase 4-6 hrs after MI and remains elevated 24-72hrs
Troponin normal: 34 weeks
• Opioid analgesics
o Meperidine
▪ Pharm action: decrease perception of pain without LOC
▪ Complications: dry mouth, neonatal depression, hypotension, decreased FHR
variability, sedation
▪ Nursing admin: verify labor is well established by vaginal exam showing cervical
dilation of at least 4cm with fetus engaged, naloxone admin only in severe resp
depression of the newborn
Chapter 33: Connective Tissue Disorders
• Disease-modifying antirheumatic drugs
o Hydroxychloroquine (antimalarial agent)
▪ Complications: retinal damage (blindness) – have eye exams q6mos
o Pharm action:
▪ Glucocorticoids: symptomatic relief of inflammation and pain
▪ NSAIDs: provide rapid relief of pain and inflammation
o Complications:
▪ Methotrexate: increased risk of infections, hepatic toxicity, bone marrow
suppression
▪ Cyclosporine: risk of infection (graft vs host disease), hepatotoxicity,
nephrotoxicity, hirsutism
▪ Glucocorticoids: risk of infection
o Contraindications:
▪
•
azathioprine (same concept as cyclosporine): pregnancy, chicken pox, herpes
zoster virus
Antigout medications
o Colchicine (once considered a drug of choice but is now reserved for clients who do not
respond/can’t tolerate the safer agents (NSAIDs/Glucocorticoids)
▪ Pharm action: only effective for inflammation caused by gout
▪ Ther use: Prednisone is used for clients who have acute gout who are unable to
take or are unresponsive to NSAIDs. This med is not for patients who have
hyperglycemia.
▪ Interactions: grapefruit juice/grapefruit
o Agents for hyperuricemia (allopurinol)
▪ Ther use: hyperuricemia due to chronic gout or secondary to chemo
▪ Interactions: warfarin (increase bleeding risk)
o Probenecid
▪ Interactions: salicylates – lessen effectiveness of medication
o Nursing admin: avoid alcohol and foods high in purine
o Nursing effectiveness: improvement of pain caused by gout attack (decrease in joint
swelling, tiredness, uric acid levels), decrease in number of gout attacks, decrease in uric
acid levels
Chapter 34: Bone disorders
• Calcium supplements
o Calcium Citrate
▪ Ther use: hypocalcemia or deficiencies of parathyroid hormone, vitamin D, or
dietary calcium
▪ Complications: hypercalcemia (>10.5mg/dL, muscle weakness, constipation,
abdominal pain).
• Selective estrogen receptor modulator (agonist/antagonist)
o Raloxifene
▪ Pharm action: decreases bone resorption
▪ Ther use: postmenopausal osteoporosis, protects against breast cancer
▪ Complications: hot flashes, leg cramps
▪ Nursing admin: consume adequate amounts of calcium rich foods and vitamin D
(egg yolks), monitor bone density, monitor serum calcium
• Bisphosphonates
o Alendronate
▪ Pharm action: inhibit bone resorption
▪ Ther use: postmenopausal osteoporosis, Paget’s disease of the bone
▪ Complications: esophagitis, GI disturbances, musculoskeletal pain, visual
disturbances
▪ Nursing admin: monitor bone density, monitor serum calcium
▪ Client education: take first thing in am after out of bed, take on empty stomach
(drink 8oz water with tables and 2oz water with liquid), sit or ambulate for 30
minutes after taking medication
• Calcitonin
o Calcitonin-salmon
▪ Ther use: postmenopausal osteoporosis, severe Paget’s disease, hypercalcemia
caused by hyperparathyroidism, cancer
▪ Complications: nausea, nasal dryness/irritation (intranasal route)
▪ Nursing admin: check for Chvostek’s and Trousseau’s signs of hypocalcemia,
monitor bone density, consume calcium and vitamin D
Chapter 35: Nonopioid Analgesics
• NSAIDs
o Aspirin/Ibuprofen/Naproxen/Indomethacin
▪ Ther use: inflammation suppression, mild to moderate pain, reduce fever
▪ Complications: GI discomfort, GI bleeding, Impaired kidney function
▪ Contraindications: pregnancy, peptic ulcer disease, bleeding disorders, allergies
to these meds
▪ Interactions: alcohol increases risk of bleeding
o Aspirin
▪ Complications: Reye syndrome (children or adolescents), aspirin toxicity
▪ Contraindications: children with flu or chicken pox
o Ketorolac
▪ Contraindications: clients with advance kidney disease, do not use longer than 5
days
o Celecoxib
▪ Contraindications: last choice for chronic pain due to increased risk of MI and
stroke, allergy to sulfonamides
• Acetaminophen
o (Tylenol)
▪ Ther use: pain and fever relief
▪ Complications: acute toxicity (liver) – nausea, vomiting, diarrhea
▪ Nursing admin: do not exceed 4g/day, limit OTC dose of acetaminophen when
taking script for combination analgesics that contain acetaminophen, antidote is
acetylcysteine
Chapter 36: Opioid Agonists and Antagonists
• Opioid agonists
o Morphine/Fentanyl/Oxycodone
▪ Complications: resp depression (stop opioids if the clients resp rate is less than
12/min), constipation, hypotension, urinary retention, sedation, nausea, vomiting
▪ Nursing admin: assess pain regularly, take baseline VS, administer IV opioids
slowly over 4-5 min, have naloxone and resuscitation equipment available, for
cancer pt. administer around the clock regularly.
• Agonist-antagonist opioids
o Butorphanol
▪ Nursing admin: warn clients not to increase dosage without consulting the
provider
• Opioid antagonists
o Naloxone
▪ Ther use: reversal of opioids and its effects
▪ Complications: tachycardia, tachypnea, abstinence syndrome (HTN)
▪ Nursing admin: monitor respirations for up to 2 hours after use
Chapter 37: Adjuvant Meds for Pain
• Tricyclic antidepressants: Amitriptyline
• Anticonvulsants: Carbamazepine, Gabapentin
Chapter 38: Miscellaneous Pain Medication
• Migraine Medications
o Sumatriptan
▪ Complications: coronary artery vasospasm/angina, dizziness or vertigo
o Ergotamine
▪ Complications: GI discomfort (nausea/vomiting), ergotism (muscle pain,
paresthesias in fingers and toes, peripheral ischemia), physical dependence, fetal
harm or abortion
▪
Interactions: Aspirin-like meds (NSAIDs/acetaminophen combination),
steroids/alcohol/tobacco (GI effects increase), NSAIDs (increase bleeding)
▪ Nursing admin: advise clients who have migraines to avoid triggers (stress,
alcohol, tyramine-containing food), lie down in dark quiet place
• Local Anesthetics
o Lidocaine
▪ Pharm action: blocking conduction of pain impulses
▪ Ther use: minor surgical procedures, regional anesthesia
▪ Complications: CNS excitation (seizures, resp depression, leading to
unconsciousness), hypotension/cardio-suppression (bradycardia, heart block,
cardiac arrest: common in spinal anesthesia due to sympathetic block), spinal
headache, urinary retention (spinal anesthesia), labor can be prolonged
o Topical EMLA cream: apply to intact skin 1 hour before routine procedures or superficial
puncture and 2 hour before more extensive procedures or deep puncture, prior to the
procedure, remove the dressing and clean the skin with aseptic solution
Chapter 39: Diabetes Mellitus
• Insulin
o Nursing admin: tell clients to admin SQ in the same general area for consistent rates of
absorption: thigh (lowest), upper arm, abdomen (highest), ensure proper storage:
unopened stored in fridge, vials of premixed insulins can be stored for up to 3 months
under refrigeration, premixed syringes can be kept in fridge for 1-2 weeks in vertical
position with needles pointing up (gently move syringes back and forth before admin),
store vial that is in use at room temp, avoid sunlight and intense heat and discard after 1
month.
• Oral antidiabetics:
o Ther use: Type 2 DM
o Sulfonylureas
▪ Glipizide/Glyburide
• Pharm action: insulin release from the pancreas
• Complications: hypoglycemia, photosensitivity
• Nursing admin: best taken with breakfast, wear sunscreen
o Meglitinides
▪ Repaglinide
• Pharm action: insulin release from the pancreas
• Complications: hypoglycemia, angina
• Nursing admin: eat within 30 min of taking a dose TID
o Biguanides
▪ Metformin
• Pharm action: reduces production of glucose in the liver, increases
muscles’ glucose uptake and use
• Complications: GI effects, Vitamin b12 and folic acid deficiency, lactic
acidosis
• Discontinue if have surgery
o Thiazolidinediones
▪ Pioglitazone
• Pharm action: Decreases insulin resistance, increases glucose uptake and
decreases glucose production
• Complications: fluid retention, elevations in LDL cholesterol,
hepatotoxicity
• Contraindications: severe heart failure
• Nursing admin: take once daily with or without food
o
Alpha-glucosidase inhibitors
▪ Acarbose
• Slows carb absorption and digestion
• Complications: GI effects, anemia due to decrease of iron absorption,
hepatoxicity with long term use
• Nursing admin: take with first bite of food TID
• Hyperglycemic agent
o Glucagon
▪ Pharm action: increasing the breakdown of glycogen into glucose
▪ Ther use: Emergency management of hypoglycemic reactions (such as insulin
overdose) in clients who are unable to take oral glucose
▪ Complications: GI distress – nausea, vomiting
▪ Nursing admin: glucagon SQ, IM, or IV immediately following reconstitution
parameters, provide food as soon as client regains full consciousness and is able
to swallow
Chapter 40: Endocrine Disorders
• Thyroid hormone
o Levothyroxine
▪ Pharm action: synthetic form of thyroxine (T4)
▪ Complications: overmedication – heat intolerance, diaphoresis, wt. loss
▪ Nursing admin: TSH levels monitored at least once a year, daily therapy begins at
a low dose and increase gradually over several weeks (full effect can take 6-8
weeks), take on empty stomach 30-60 min before eating, check with provider
before switching brands because dosage adjustments may be necessary
• Thionamides
o Propylthiouracil
▪ Pharm action: blocks the synthesis of thyroid hormones
▪ Ther use: Grave’s Disease, thyroid removal surgery
▪ Complications: hypothyroidism (depression, wt. gain, bradycardia, cold
intolerance), agranulocytosis, liver injury/hepatitis
▪ Nursing admin: monitor CBC for leukopenia/thrombocytopenia
•
•
•
•
Radiopharmaceuticals
o Radioactive Iodine
▪ Ther use: hyperthyroidism, Thyroid cancer
▪ Complications: radiation sickness, bone marrow depression, hypothyroidism
▪ Nursing admin: maintain distance of 6 ft from others, do not prepare food for
others or share utensils, encourage clients to increase fluid intake (2-3L/day)
Iodine products
o Strong iodine solution
▪ Ther use: thyroid removal surgery, thyrotoxicosis
▪ Complications: Iodism – metallic taste/stomatitis/sore teeth and gums
▪ Nursing admin: dilute with juice to improve taste, increase fluids, avoid salt and
seafood
Anterior pituitary hormones/growth hormones
o Somatropin
▪ Nursing admin: IM or SQ, monitor growth plates monthly (stop before plates
close), rotate injection site
Antidiuretic hormone
o
Vasopressin/Desmopressin
▪ Ther use: used to treat diabetes insipidus (DI)
▪ Complications: reabsorption of too much water, myocardial ischemia (notify of
chest pain, tightness, or diaphoresis)
▪ Nursing admin: monitor VS/I&O, monitor BP and HR, monitor for h/a, confusion,
and other indications of water intoxication
▪ Nursing effectiveness: reduction in large volumes of urine output associated with
Diabetes insipidus to normal levels (1.5-2L/day), cardiac arrest survival
• Adrenal hormone replacement
o Hydrocortisone
▪ Pharm action: mimic natural steroid hormones
▪ Ther use: Addison’s disease/adrenal crisis
▪ Complications: osteoporosis, adrenal suppression, peptic ulcer/GI discomfort,
infection, Cushing’s syndrome
▪ Interaction: NSAIDs and alcohol can increase gastric distress or bleed
▪ Nursing admin: observe for peptic ulcer 9coffee ground emesis/ blood or tarry
stools, do not stop abruptly, increase doses during times of stress
Chapter 41: Immunizations
• Artificial active immunity – killed or attenuated vaccine
• Natural active immunity
• Natural passive immunity – mother to fetus, then to newborn through colostrum
• Artificial passive immunity – immune globulins protect against disease after exposure has
occurred
• Complications: allergic reaction, mod/severe illness with or without fever (precaution), common
cold and minor illnesses are not contraindicated or a precaution for vaccines
• IPV – do not give if allergic to neomycin/streptomycin/polymyxin B
• Varicella – do not give if allergic to neomycin or gelatin
• Hep B – do not give if allergic to yeast
• Inactivated flu vaccine - do not give if has had GBS within 6 weeks
• Live flu vaccine - do not give if pt. has had GBS within 6 weeks
• HPV4/9 - do not give if allergic to yeast
• HPV2 - do not give if allergic to latex
• Nursing admin: avoid aspirin in children, document correctly, know where vaccine should be
placed
Chapter 42: Chemotherapy agents
• Antimetabolites
o Methotrexate
• Antitumor antibiotics
o Doxorubicin
▪ Pharm action: binds to DNA, altering its structure, therefore, inhibits synthesis of
DNA and RNA (intercalation)
▪ Ther use: solid tumors
▪ Complications: bone marrow suppression, GI effects, alopecia, acute cardiac
toxicity, cardiomyopathy, heart failure, red coloration of urine and sweat
▪ Nursing admin: Monitor CBC and liver enzymes, admin antiemetic for nausea and
vomiting, monitor ECG and cardiac function
• Antimitotics:
o Vincristine
▪ Pharm action: stop cell division during mitosis, M-phase specific
▪ Complications: peripheral neuropathy (paresthesia), severe tissue damage (use
central line), alopecia
•
•
▪ DOES NOT CAUSE BONE MARROW SUPPRESSION
Alkylating agents
o Cyclophosphamide
▪ Pharm action: kills rapid growing cells by alkylation of DNA and RNA synthesis
▪ Ther use: acute lymphomas, solid tumors
▪ Complications: bone marrow suppression, GI discomfort (nausea/vomiting),
acute hemorrhagic cystitis, alopecia
▪ Nursing admin: encourage adequate fluid intake, monitor for blood in urine,
monitor for bleeding, give antiemetic
Hormonal agents: prostate cancer meds
o Leuprolide
▪ Pharm action: testes stop producing testosterone by stopping the release of LH
and FSH
▪ Complications: hot flashes, decreased libido, gynecomastia, decreased bone
density (increase calcium and vitamin D)
▪ Nursing admin: monitor PSA and testosterone levels (both should decrease)
• Hormonal agents: breast cancer meds
o Tamoxifen
▪ Pharm action: stops growth of breast cancer cells which are estrogen-dependent
cancers
▪ Complications: endometrial cancer, hypercalcemia, PE, hot flashes
• Biologic Response Modifiers
o Interferon alfa-2b
▪ Pharm action: increases immune response and decreases production of cancer
cells
▪ Complications: flu-like symptoms, bone marrow suppression, alopecia,
cardiotoxicity, neurotoxicity, depression, anxiety insomnia, altered mental status
Chapter 43: Principles of antimicrobial therapy
• Selection of antimicrobials
o ID of causative agent
▪ Lab testing of body fluids such as blood/urine/sputum/wound drainage
▪ Gram stain: exam under microscope
▪ Culture: preferred when gram stain does not give a positive ID, collect specimen
PRIOR to antibiotic therapy
Chapter 44: Antibiotics Affecting the bacterial cell wall
• Penicillins
▪ Pharm action: kill bacteria by weakening cell wall
▪ Complications: allergies/anaphylaxis, renal impairment
▪ Nursing admin: Give IM injections cautiously to avoid injecting into nerve or
artery
o Penicillin-G
▪ Interactions: do not mix penicillin and aminoglycosides in the same IV solution
o Amoxicillin
o Piperacillin tazobactam
• Cephalosporins
o Cephalexin/Cefazolin/Ceftriaxone
▪
Complications: allergic reaction, suprainfection, thrombophlebitis (rotate
injection sites, admin dilute intermittent infusion or slowly over 3-5 minutes),
pain with IM injection (deep ventrogluteal site preferred)
•
Carbapenems
o Imipenem-cilastatin
▪ Complications: GI upset, cross-sensitivity to penicillin or cephalosporins,
suprainfection
• Other inhibitors of cell wall synthesis
o Vancomycin
▪ Ther use: C. diff
▪ Complications: ototoxicity, infusion reactions (admin slowly over 60 minutes),
thrombophlebitis (rotate injection sites), renal toxicity
▪ Nursing admin: monitor vancomycin trough levels, need to do creatinine levels to
indicate IV dosing
Chapter 45: Antibiotics Affecting Protein Synthesis
• Tetracyclines
o Tetracycline/Doxycycline
▪ Pharm action: bacteriostatic
▪ There use: acne vulgaris, Rocky mounted spotted fever, Lyme disease
▪ Complications: GI discomfort, yellow or brown tooth discoloration/hypoplasia of
tooth enamel (avoid admin in children <8yo and women who are pregnant),
hepatoxicity, photosensitivity, superinfection
▪ Contraindications: taking after 4th month of pregnancy can stain deciduous teeth
but does not affect deciduous teeth. Does stain permanent teeth of children
4mos to 8yo
▪ Interactions: avoid milk products and antacids or separate by 2 hours, milk
products/calcium/iron/laxatives with magnesium/antacids
▪ Nursing admin: take on empty stomach with 8oz of water, do not take right
before laying down (esophageal ulceration), use additional contraception
• Macrolides
o Erythromycin/Azithromycin
▪ Pharm action: bacteriostatic
▪ Ther use: used in clients allergic to penicillin, treats legionnaire’s
disease/pertussis/diphtheria, and treats chlamydia
▪ Complications: GI upset, dysrhythmias (do not use in clients with prolonged QT
intervals), ototoxicity (report hearing loss, vertigo and tinnitus)
▪ Nursing admin: admin on an empty stomach with 8 oz of water (1 hr before/2 hr
after meals), erythromycin IV only for severe infections, monitor PT/INR for those
who take warfarin concurrently, monitor LFTs for therapy lasting longer than 2
weeks
•
Aminoglycosides
o Gentamicin
▪ Complications: Ototoxicity, nephrotoxicity
▪ Nursing admin: peak – 30 min after admin IM or IV, trough – right before next
dose
Chapter 46: Urinary Tract Infections
• Sulfonamides and trimethoprim
o Trimethoprim-sulfamethoxazole
▪
▪
Pharm action: preventing the synthesis of a folic acid derivative
Complications: blood dyscrasias, crystalluria (encourage adequate oral fluid
intake)
• Urinary tract antiseptics
o Nitrofurantoin
▪ Pharm action: injures bacteria by damaging DNA
▪ Complications: GI upset, hypersensitivity reactions, blood dyscrasias, peripheral
neuropathy
▪ Nursing admin: turns urine rust yellow to brown and can stain teeth
• Fluoroquinolones
o Ciprofloxacin
▪ Pharm action: inhibition of an enzyme necessary for DNA replication
▪ Complications: GI upset, Achilles tendon rupture, suprainfection (thrush)
• Urinary tract analgesic
o Phenazopyridine
▪ Pharm action: local anesthetic on the mucosa of the urinary tract
▪ Ther use: relieves manifestations of burning with urination, pain, frequency, and
urgency
▪ Nursing admin: changes urine to an orange-red color
Chapter 47: Mycobacterial, fungal, and parasitic infections
• Antimycobacterial (selective antituberculotic)
o Isoniazid
▪ Ther use: indicated for active OR latent TB
▪ Complications: peripheral neuropathy, hepatotoxicity
▪ Interactions: tyramine foods and alcohol
• Broad spectrum antimycobacterial (antituberculotic)
o Rifampin
▪ Ther use: given in combination with at least one other med to prevent antibiotic
resistance
▪ Complications: discoloration of body fluids (orange color of urine, saliva, sweat,
and tears), hepatotoxicity (anorexia, malaise, fatigue, and avoid alcohol), Gi
discomfort (nausea, anorexia, abdominal discomfort), pseudomembranous colitis
(fever, diarrhea, abdominal pain, bloody stool)
▪ Contraindications: avoid alcohol
▪ Nursing admin: use non-hormonal contraceptives
▪ Nursing effectiveness: improvement of TB such as clear breath sounds, no night
sweats, increased appetite, and no afternoon rises of temperature. Three
negative sputum cultures for TB (3-6 months)
• Antiprotozoal
o Metronidazole
▪ Ther use: treatment of protozoal infections and obligate anaerobic bacteria, H.
pylori in combo with tetracycline and bismuth subsalicylate in clients who have
peptic ulcer disease
▪ Complications: GI discomfort, metallic taste, darkening of urine
▪ Interactions: alcohol
▪ Nursing effectiveness: resolution of bloody mucoid diarrhea, formed stools,
negative for giardia, decrease or absence of discharge, negative blood cultures
• Antifungals
o Ketoconazole/Amphotericin B
▪ Therapeutic use ➔ systemic fungal infections
▪
Complications: test dose of amphotericin B to assess for reaction,
thrombophlebitis, nephrotoxicity, bone marrow suppression, hepatotoxicity
(jaundice/clay colored stools/dark urine)
▪ Nursing effectiveness: improvement of systemic fungal infection
Chapter 48: Viral Infections, HIV, AIDS
• Antivirals
o Acyclovir
▪ Ther use: Herpes/Varicella -zoster virus,
▪ Complications: Phlebitis/nephrotoxicity,
▪ Nursing admin: inform clients to expect relief of manifestations, but not a cure
o Ganciclovir
▪ Therapeutic use ➔ cytomegalovirus
▪ Complications: suppressed bone marrow
VERSION 5
PHARMACOLOGY REVIEW
CHAPTERS 1-5 ATI BOOK TEST #1
1. The client was switched from a brand-named drug to a generic version of the same drug. The nurse
knows to assess the client’s response because:
Answer: it is possible for the client to respond in a different manner to the generic version.
2. The client is an elderly woman with mild liver damage due to hepatitis. The nurse is aware that the
client may need reduced dosages of medications because:
Answer: the drugs may accumulate in the client’s body and produce toxicity.
3. The client asks the nurse if she should take the herb ginkgo to help with her forgetfulness. The nurse’s
best response:
Answer: herbal medicines are not regulated by the FDA, therefore, their safety and effectiveness cannot
be established.
4. The study of how drugs are best used to treat illness is called:
Answer: pharmacotherapeutics
5. Sterile sealed glass containers that hold a single liquid dose are called:
Answer: ampules
6. During the earliest stages of development, the first name applied to a new drug is its:
Answer: chemical name
7. Under the controlled substances act of 1970, schedule 1 drugs are those that have:
Answer: high potential for abuse and no accepted medical use in the united states.
8. Drugs that are administered via the sublingual route:
Answer: are absorbed directly into the bloodstream
9. After receiving numerous does of a narcotic for pain, the client seems to require the medication more
often and states that it does not seem to be working now. The nurse understands that this probably
represents the client having developed _______ to the medication or dose.
Answer: Tolerance
10. The nurse understands that when administering a medication, the route of administration primarily
affects the drugs:
Answer: absorption
11. A client taking a medication to increase the time it takes to clot her blood (anticoagulant) has a long
history of using herbal agents. Which of the following statements made by the client would indicate the
need for further teaching?
Answer: I can continue to use the garlic for dietary supplement to decrease my cholesterol
12. A client has renal insufficiency and is taking multiple medications. The nurse understands that:
Answer: the client may need to have lower dosages, because of the risk of accumulation of the
medications
13. A client has renal insufficiency and is taking multiple medications. The nurse understands that:
Answer: the client may need to have lower dosages, because of the risk of accumulation of the
medication.
14. What action should the nurse take before administering a drug in suspension form?
Answer: Shake the suspension thoroughly
15. Green tea contains small amounts of vitamin k. thus, oral use can decrease the properties of which of
the following medications?
Answer: Warfarin
16. A second-year nursing student is preparing to administer medications to clients in a small rural
hospital. The questions that follow review some of the information she will need to know to administer
medication safely and effectively. Which of the following abbreviations means right away?
Answer: STAT
17. A second-year nursing student is preparing to administer medications to clients in a small rural
hospital. The questions that follow review some of the information she will need to know to administer
medications safely and effectively. The type of syringe most frequently used for allergy injections is a:
Answer: tuberculin syringe
18. A second-year nursing student is preparing to administer medications to clients in a small rural
hospital. The questions that follow review some of the information she will need to know to administer
medications safely and effectively. Medications administered under the tongue are said to be given:
Answer: sublingually
19. Which of the following routes frequently requires use of a 22 gauge, 1 ½ inch needle?
Answer: Intramuscular
20. When pouring liquid medications, the nurse knows to raise the measuring device to eye level and to
read the measurement at:
Answer: the lowest point of the meniscus
21. When administering ear drops to children less than 3 years old, the pinna is:
Answer: pulled back and down
22. The nurse receives a medication prescription with no route specified. What is the best action by the
nurse?
Answer: Call the health care provider to clarify the prescription
23. When a nurse discovers that a client is not taking medications as prescribed, it is the nurse’s
responsibility to do which of the following?
Answer: Ask the client why he or she is not taking the medications as prescribed
24. Which of the following measures is equivalent to 30ml?
Answer: 2 tablespoons
25. Which of the following measures is equivalent to 1 grain?
Answer: 60 milligrams
26. The client with a nasogastric tube is prescribed four medications via the tube. The nurse is aware that
optimal administration of these medications is by which of the following methods?
Answer: Crush tablets and pace each into a separate medication administration cup diluted in warm
water.
27. Which of the following interventions is essential for the nurse to perform when caring for a client
receiving an intravenous drug infusion?
Answer: Monitor the client during the infusion
28. When preparing to administer an intravenous push medication via a primary infusion, the nurse must
first:
Answer: check compatibility of the medication with the infusion fluid
29. The nurse is initiating an intravenous access. After the vein has been pierced by the IV needle, which
of the following would be indicative that the needle is in the vein?
Answer: Backflow of blood into the tubing
30. In the preparation of an intravenous infusion, the nursing action necessary to prevent air embolism is
to:
Answer: prime the tubing of the intravenous administration set.
31. The nurse assesses the client’s IV site and determines that it has infiltrated. The nurse’s best response
is to:
Answer: immediately stop the IV infusion
32. A client’s peripheral IV infusion setup was initiated 3 days ago. The nurse realizes that there is a need
to:
Answer: change (rotate) the IV site
33. The nurse understands that which of the following are necessary pieces of information needed when
measuring the plasma concentration of a drug? Select all that apply.
Answer: Clients renal, hepatic, and cardiovascular functioning status, clients use of other medications,
clients age and weight
34. How are subcutaneous injections administered? Choose all that apply.
Answer: 45-degree angle, 90-degree angle, in the subcutaneous tissue
35. When attempting venipuncture, if applying a tourniquet fails to raise an appropriate vein, the nurse
may try which of the following? Select all that apply.
Answer: Instruct client to open and close a fist, apply warm compresses for 10 to 15 minutes to the site of
the appropriate vein, request the client lower the body part to below
36. The nurse understands that besides extravasation, pain at the site of an IV infusion can result from
which of the following? Select all that apply.
Answer: Administering irritating medications too rapidly, the IV catheter touching the wall of the vein,
administering medication that is not properly diluted
37. The gauge of the IV needle is determined by which of the following factors? Select all that apply.
Answer: Viscosity of the medication, condition of the vein selected, nature of the therapy, size of the vein
selected.
38. Which of the following dosage forms should NOT be disrupted? Choose all that apply.
Answer: Entericcoated medications, vaginal suppositories, gel tablets, sustained action medications,
products containing a wax matrix.
39. Which of the following Is true of intravenous therapy? Select all that apply.
Answer: It is used to maintain water balance, it is used as nutritional therapy, it can prove fatal if
incorrect fluid is infused, blood and blood products are IV solutions, IV fluids are prescribed according to
osmolality of the fluid, it is used as a replacement therapy
40. If the half-life of an antibiotic is 6 hours, the percentage of the original dose that will remain in the
clients body 24 hours after a single dose has been administered is:
Answer: 6.25%
41. The study of the biochemical and physiological effects of drugs as well as their mechanisms of action
is called:
Answer: pharmacodynamics
42. Soft gelatin capsules are most commonly employed in:
Answer: liquid drugs
43. Because aspirin can be purchased without a prescription order form, it is called an:
Answer: over the counter drug
44. The process by which a drug passes into the fluids of the body is called:
Answer: absorption
45. Drug molecules that are bound to plasma proteins are:
Answer: pharmacologically inactive
46. The minimal level of drug required to elicit a pharmacological response is called:
Answer: minimum effect concentration
47. When the pharmacological effects of one drug are potentiated or diminished by another drug, it is
called:
Answer: interaction
48. A physician has prescribed enteric coated tablets for the client. The nurse knows that which of the
following is true about enteric- coated tablets?
Answer: Tablets are designed to carry drugs that can irritate the stomach
VERSION 6
Pharmacology ATI Exam
Chapter 1: Pharmacokinetics and Routes of Administration
• Absorption – how quickly or how well it is absorbed; DEPENDS ON THE ROUTE
o Oral – takes a while, must pass through the GI tract
▪ Food can SLOW this down
▪ pH juices play a role
▪ Liquids vs extended release tablets
o Sublingual – quick, under the tongue
o Intradermal/topical – slow, gradual
o Intravenous (IV) – the FASTEST route; immediate absorption
• Distribution – requires binding proteins of medication
o Albumin is a common binding protein
• Metabolism – medication is inactivated
o Occurs primarily in the LIVER
o Factors that Influence Metabolism:
▪ Age – dysfunction of liver
▪ Children – metabolism is not mature yet
o
•
•
•
•
•
•
First-pass effect – medications are inactivated through their first pass of the liver;
THEREFORE, you may need a HIGHER DOSE of the medication to reach therapeutic
effects
Excretion – primarily done by the KIDNEYS
Therapeutic Index
o HIGH TI = wide safety margin, no need for routine monitoring
o LOW TI = small safety margin; NEEDS MONITORING; HIGH risk of toxicity
▪ Ex: vancomycin; need to draw peak/trough blood levels
Half-life – the amount of time it takes for the medication in the body to drop by 50%
o Short half-life – leaves the body quickly
o Long half-life – lingers in the body for long periods; HIGH risk of toxicity
Agonist – medication designed to produce an action
Antagonist – opposes the action
Nursing Considerations for Routes of Administration
o Oral:
▪ May need to mix with apple sauce
▪ Want patient to sit up/Fowler’s position
▪ “Chin to chest” to help with swallowing
▪ REMEMBER! NEVER chew enteric-coated capsules
▪ REMEMBER! Never break/chew extended-release capsules
o Sublingual/buccal:
▪ Keep medication in place until it is completely dissolved
▪ DO NOT eat/drink until it is completely dissolved
o Transdermal:
▪ Wash and dry thoroughly
▪ Place patch on a hairless area
▪ Rotate patch sites
o Eyes:
▪ Put into conjunctival sac
▪ Apply pressure to the nasolacrimal duct
▪ Wait 5 minutes between different drops
▪ Never touch the eye with the dropper (1-2 cm away)
o Ears:
▪ Lay on unaffected side
▪ Pull up and out if they are an ADULT
▪ Pull down and back if they are a CHILD
o NG/Nose:
▪ Flush before and after with 15 ml
▪ One last flush of 15 ml-30 ml
o Suppository:
▪ Place just beyond the external sphincter
▪ Left lateral sims’ position
o Inhalation:
▪ MDI (meter dose inhaler)
• SHAKE 5-6 TIMES
• TAKE DEEP BREATH 3-5 secs
• HOLD BREATH 10 secs
▪ DPI (dry powder inhaler)
• AVOID SHAKING INHALER
• HOLD BREATH 10 secs
o Intramuscular:
▪
▪
▪
REMEMBER! VASTUS LATERALIS for children under 2 years-old
REMEMBER! DELTOID site MAX 1 mL of fluid
REMEMBER! Z-TRACK prevents medication from walking back into
subcutaneous tissue
Chapter 2: Safe Medication Administration and Error Reduction
• Routine/standard – regular schedule medication
• One-time – only one dose
• STAT – immediately
• PRN – as needed
• Medication reconciliation – comparing at home medications with hospital medications
o Done UPON ADMISSION
o Done UPON TRANSFER
o Done AT DISCHARGE
• REMEMBER! NEVER use trailing 0
• REMEMBER! ALWAYS use leading 0
• REMEMBER! NEVER administer a medication prepared by someone else
• REMEMBER! NEED to fill out INCIDENT REPORT if given the WRONG MEDICATION
o INCIDENT REPORTS DO NOT GO IN THE PATIENT’S CHART
Chapter 4: Intravenous (IV) Therapy
• Risks Associated with IV Therapy
o Circulatory overload if the dose is too large or too rapid
o Little time to correct errors
o Failure to maintain surgical asepsis
• DOs and DON’Ts
o REMEMBER! NEVER put IV meds through tubing that is infusing blood or blood
products
o REMEMBER! NEVER infuse meds through tubing that is administering TPN
o Verify compatibility of medications
o Use a BP cuff instead of tourniquet; especially for OLDER ADULTS
o Hold arm below the level of the heart
o Try to stay away from back of hand
o Want to change sites (usually every 72 hours)
o REMEMBER! Fluids should NOT hand for more than 24 hours UNLESS it is a CLOSED BAG
SYSTEM
o Start distally 1st
o Flush IV every 8-12 hours to keep patency
o Monitor every hour at the least
• Complications
a. Infiltration – solution outside of the veins
i. PALLOR, SWELLING, COLDNESS
b. Extraversion – medication leaking outside of the veins
i. PAIN, BURNING, REDNESS, SWELLING
c. Hematoma – bruising at the site
d. Catheter embolus (VERY SERIOUS SITUATION) – missing catheter tip after
discontinuation
e. Phlebitis –
i. EDEMA, WARMTH, BURNING, PAIN
f. Cellulitis –
i. PAIN, WARMTH, EDEMA
ii. SYSTEMIC SYMPTOMS: MALAISE, FEVER
g. Fluid overload –
i. DISTENDED NECK VEINS, HYPERTENSION, TACHYCARDIA, CRACKLES, DYSPNEA
Chapter 6: Individual Considerations of Medication Administration
• Factors Affecting Medication Dosages and Responses
o Body weight – the bigger someone is, the higher the dose will need to be to get
therapeutic effects
o Age – Young children will need a smaller dose because their liver/kidneys are not fully
developed, blood-brain barrier poorly developed, increased ability to absorb topical
medications; older client’s liver/kidney function may be impaired
o Gender – females have a higher proportion of body fat
o Tolerance (IV DRUG USERS)
o Accumulation – if someone has impaired kidney function, they may not be able to
excrete it properly which could lead to toxicity
o Psychological factors – someone’s frame of mind can impact effects
o Medical problems –
▪ Diarrhea
▪ Inadequate gastric acids
▪ Liver disease
▪ Kidney disease
• Pregnant
o REMEMBER! MOST OF THE TIME it is NOT okay to take medications while pregnant
o REMEMBER! Pregnant women should NOT have live vaccines (measles, mumps, rubella,
polio)
o REMEMBER! They should get the INACTIVATED INFLUENZA vaccine
Chapter 7: Anxiety and Trauma-and Stressor-Related Disorders
• Benzodiazepines (end in –am)
o Diazepam
o Lorazepam
o Alprazolam
o Chlrodiazepoxide
▪ Use: treatment of ANXIETY, seizures, muscle spasms, alcohol withdraw
▪ Action: increase the effects of GABA in your body
▪ SE: SEDATION, RESPIRATORY DEPRESSION, amnesia, dependency, withdraw
▪ Recommended for SHORT-TERM use
▪ NEVER just quit taking
▪ Antidote: FLUMAZENIL
• Atypical anxiolytic (anti-anxiety)
o Buspirone
▪ Use: ANXIETY, PANIC DISORDER, OCD, PTSD
▪ KEY POINTS:
• CAN BE USED LONG TERM
• SEDATION IS USUALLY NOT A PROBLEM
• TAKES A FEW WEEKS FOR THERAPEUTIC EFFECTS TO APPEAR
• DEPENDENCY RISK IS LOW
▪ SE: dizziness, nausea, headache
▪ (PAM HAS ANXIETY WENT ON A BENZO AND TAKES IT FOR A ONG TIME BUT
REALIZES IT IS NOT HEALTHY SO SHE TAKES A BUS TO A PIER AND REALIZES SHE
IS GOING TO BE HEALTHIER AND TAKE BUSPIRONE)
• SSRI’s (end in –ine)
o Paroextine
o Sertaline
o Fluoxetine
▪
▪
Use: ANXIETY, DEPRESSION, OCD, PTSD
Action: inhibit serotonin reuptake (increases the amount of serotonin in the
body)
▪ (TEENS (-ines) CAN BE DIFFICULT AND CAUSE PARENTS TO HAVE ANXIETY AND
DEPRESSION)
▪ SE: nausea, fatigue, WEIGHT GAIN, SEXUAL DYSFUNCTION
▪ WATCH FOR SERITONIN SYNDROME (TOO MUCH SERETONIN) SE: agitation,
hallucinations, fever, tremors
▪ TAKES A FEW WEEKS FOR THERAPEUTIC EFFECTS TO APPEAR
Chapter 8: Depressive Disorders
• SSRI’s (end in –ine)
o Paroextine
o Sertaline
o Fluoxetine
▪ Use: DEPRESSION
▪ Action: inhibit serotonin reuptake (increases the amount of serotonin in the
body)
▪ SE: WEIGHT GAIN, SEXUAL DYSFUNCTION, nausea, fatigue
▪ WATCH FOR SERITONIN SYNDROME (TOO MUCH SERETONIN) SE: agitation,
hallucinations, fever, tremors
▪ TAKES A FEW WEEKS FOR THERAPEUTIC EFFECTS TO APPEAR
• Atypical Antidepressants
o Buproprion
o Trazadone (MAJOR SE IS SEDATION)
▪ Use: DEPRESSION, SMOKING CESSATION
▪ SE: insomnia, weight loss, GI distress, agitation, seizures, headache
▪ (B APPROPRIATE AND DON’T SMOKE OR YOU’LL GET DEPRESSION)
• Tricyclic Antidepressants
o Amitriptyline
▪ Use: DEPRESSION, NEUROPATHY, BIPOLAR DISORDER
▪ (AMI TRIPPED OVER A TRICYLE IN THE DESSERT)
▪ SE: ANTICHOLINERGIC (CAN’T PEE, CAN’T SEE, CAN’T SPIT, CAN’T SHIT)
▪ KEY POINTS:
• IN ORDER TO COUNTERACT THESE SE’S → CHEW GUM, WEAR
SUNGLASSES, DRINK LOTS OF FLUIDS, HIGH FIBER DIET
• MOST SERIOUS? Urinary retention
• MAOI’s
o Phenelzine
▪ Use: DEPRESSION
▪ THERE ARE A LOT OF DRUG INTERACTIONS
▪ SE: agitation, anxiety, orthostatic hypotension, HYPERTENSIVE CRISIS
▪ IF YOU EAT FOODS RICH IN TYRAMINE, YOU CAN TRIGGER THE HYPERTENSIVE
CRISIS
▪ (I AM A PHENE FOR AGED CHEESES, BOLOGNA, WINE, AVACODO, SOY SAUCE,
SALAMI, PEPPORONI, ETC BECAUSE OF MY DEPRESSION)
Chapter 9: Bipolar Disorders
• Mood stabilizer
o Lithium carbonate
▪ Use: bipolar disorder
▪ SE: GI UPSET, FINE HAND TREMORS (COURSE HAND TREMORS ARE A SIGN OF
TOXICITY), weight gain, renal toxicity
▪ NEED ADEQUATE FLUID INTAKE!
▪ IF LITIUM LEVELS ARE OVER 1.5 → INDICATES TOXICITY
▪ STAY AWAY FROM DIURETICS AND ANTICHOLINERGIC MEDS AND NSAIDS
• Antiepileptic drugs
o Valproic acid (SE: HEPATOXICITY *)
o Carbmazepine (SE: anemia, leukocytopenia, etc)
▪ Use: BIPOLAR DISORDER, anti-seizures
Chapter 10: Psychotic Disorders
• Antipsychotics (conventional)
o Chlorpromazine
o Haloperidol
▪ Use: psychotic disorders (schizophrenia, tourettes syndrome)
▪ SE: A BUNCH OF SIDE EFFECTS, EXTRAPYRAMIDAL SE’S, NEUROLEPTIC
MALIGNANT SYDROME
▪ If the patient isn’t good about taking the medication, can get IM injections every
2 weeks
• Antipsychotic (atypical)
o Risperdone
o Clozapine
▪ Use: schizophrenia
▪ SE: diabetes, weight gain, increased cholesterol, orthostatic hypotension
▪ If the patient isn’t good about taking the medication, can get IM injections every
2 weeks
▪ SHOULD AVOID ALCOHOL
Chapter 11: Medications for Children and Adolescents with Mental Health Issues
• CNS Stimulants
o Methylphenidate
o Amphetamine mixture (Adderall)
▪ Use: ADHD, conduct disorder
▪ SE: INSOMNIA, RESTLESSNESS, WEIGHT LOSS
▪ SHOULD NOT ADMINISTER AT NIGHT
▪ GIVE IMMEDIATELY BEFORE OR IMMEDIATELY AFTER A MEAL
▪ MONITOR THE CHILD’s WEIGHT
Chapter 12: Substance Use Disorders
• Alcohol withdraw – usually starts 4-12 hours after the last consumption of alcohol
o SE: vomiting, tremors, increased BP, increased RR, increased HR
WITHDRAW MEDICATIONS
• Benzodiazepines (end in –am)
• Adjunct medications to treat the high blood pressure (propranolol)
ABSTINENCE MEDICATIONS
• Disulfiram
o IF THEY TAKE THIS, THEY WILL GET THE BAD SIDE EFFECTS
• Naltrexone
o SUPPRESSES THE CRAVING FOR ALCOHOL
• Acamprosate
o DECREASES THOSE ABSTINENCE SYMPTOMS
OPIOD ADDICTION
• Methadone substitution (THINK A METHADONE CLINIC)
o Substitutes the use of opioids
o GRADUALLY TAKE THEM OFF THIS MEDICATION
NICOTINE ADDICTION
• Buproprion
o (B APPROPRIATE AND DON’T SMOKE)
Nicotine gum, nicotine patch
Varenicline (CHANTEX)
o MONITOR FOR DEPRESSION
Chapter 13: Chronic Neurologic Disorders
• Myasthenia gravis – do not have enough acetacholine at receptor sites
• Cholinesterase Inhibitors
o Neostigmine
o Physostigmine
▪ Use: treats myasthenia gravis
▪ SE: CHOLINERGIC EFFECTS
o Edrophonium
▪ USED TO DIAGNOSIS MYASTHENIA GRAVIS
o ATROPINE IS THE ATIDOTE
• Anti-Parkinson’s Medications
o Levadopa/carbidopa
▪ Use: Parkinson’s
▪ SE: nausea, vomiting, diarrhea, dyskinesia (grimacing, tics, tremors), orthostatic
hypotension, darkening of urine and sweat, psychosis
▪ YOU WANT TO EAT CARBS, BUT LESS PROTEIN BC IT CAN DECREASE THE
EFFECTIVENESS OF MED
o Benzotropine
▪ Use: Parkinson’s
▪ SE: anticholinergic effects
• Antiepileptics
o Phenytoin
▪ Use: seizures
▪ SE: gingival hyperplasia (NEED TO CONSULT YOUR DENTIST)
▪ VERY CLOSELY MONITOR PLASMA LEVELS TO AVOID TOXICITY
▪ Decreased effectiveness of oral contraceptives
Chapter 14: Eye and Ear Disorders
• Beta-adrenergic blocker
o Timolol (THESE ARE EYE DROPS)
▪ Use: decrease IOP in glaucoma
• Carbonic anhydrase inhibitor
o Acetazolamide
▪ Use: glaucoma
▪ SE: flu-like symptoms, GI effects, electrolyte imbalances
▪ Administer with food to prevent GI upset
•
Fluroquinolone Antibiotics plus steroid medications
o Ciprofloxacin plus hydrocortisone
▪ Use: otitis externa (swimmer’s ear)
Chapter 15: Miscellaneous Central Nervous System Medications
• Neuromuscular blocking agents
o Succinycholine
o Pancuronium
▪ Use: anesthesia for muscle paralysis in surgery
▪ SE: MALIGNANT HYPERTHERMIA (muscle rigidity, fever), muscle pain
▪ Administer cooling measures if they have malignant hyperthermia
▪ Administer DANTROLENE
• Muscle relaxants and antispasmodics
•
•
o
Dantrolene
▪ Use: malignant hyperthermia, muscle spasticity
▪ SE: drowsiness, muscle weakness, hepatotoxicity
o Baclofen
▪ Use: muscle spasticity, malignant hyperthermia
▪ SE: drowsiness, constipation
▪ (IF YOU PULL OUT YOUR BACK, YOU MIGHT NEED BACLOFEN AS A MUSCLE
RELAXER)
• Muscarinic agonists
o Bethanechol
▪ Use: treats urinary retention
▪ (BETH HAS A SHY BLADDER, SO THIS HELPS HER GO TO THE BATHROOM)
▪ SE: cholinergic effects
▪ Administer 1 hour before or 2 hours after meals
• Muscarinic antagonists
o Oxybutynin
▪ Use: overactive bladder, frequency, urgency, nocturia
▪ SE: anticholinergic effects
▪ Contraindicated: glaucoma
Chapter 16: Sedative-Hypnotics
• Nonbenzodiazepines
o Zolpidem
▪ Use: insomnia
▪ SE: daytime sleepiness, dizziness
▪ Make sure patient has 8 hour dedicated sleep time
• Intravenous anesthetics
o Pentobarbital sodium
o Propafal (CAN CAUSE PAIN AT THE IV SITE)
o Medazolam
▪ Use: conscious sedation, intubation procedures
▪ SE: respiratory and cardiovascular depression, HIGH RISK FOR HYPOTENSION
Chapter 17: Airflow Disorders
• Beta2 Adrenergic Agonists
o Albuterol
▪ Use: asthma, COPD
▪ SE: tachycardia, angina, tremors, jittery
• Methylxanthines
o Theophylline
▪ (IF YOU TAKE THEOPHYLLINE, YOU MIGHT BE SEEING GOD SOONER THAN YOU
INTENDED)
▪ Use: asthma, COPD
▪ SE: BAD!!!!! GI upset, dysrhythmias, seizures
▪ VERY NARROW THERAPEUTIC RANGE
▪ WILL HAVE TO HAVE FREQUENT BLOOD DRAWS
• Inhaled anticholinergics
o Ipratropium
▪ Use: asthma, COPD
▪ SE: anticholinergic effects
▪ TELL PT TO INCREASE FLUIDS
▪ SUCK ON SUGAR FREE CANDY OR CHEW GUM TO RELIEVE THE DRY MOUTH
• Glucocorticoids
o Beclomethasone
▪
▪
▪
▪
(BECKY HAS ASTHMA)
Use: asthma, can be used alone or with the albuterol (DECREASES THE
INFLAMMATION)
SE: candidiasis **
NEED TO INFORM PT TO RINSE THEIR MOUTH OUT TO PREVENT THE FUNGAL
INFECTION
o Prednisone (VERY IMPORTANT DRUG! USED FOR A WIDE VARIETY OF
THINGS; USED ALMOST ANY TIME YOU NEED TO REDUCE
INFLAMMATION)
o NEED TO KNOW ALL SIDE EFFECTS!!!!!!!
▪ Use: asthma, anything with inflammation, immune disorders
▪ SE: BONE LOSS, WEIGHT GAIN/FLUID RETENTION,
HYPERGLYCEMIA, ADRENAL GLAND SUPPRESSION, MYOPATHY
(MUSCLE WEAKNESS), PEPTIC ULCER DISEASE, INFECTION !!!!!
NEED TO KNOW ALL
▪ NEVER SUDDENLY STOP TAKING! MUST TAPER OFF
▪ MONITOR FOR SIGNS AND SYMPTOMS OF INFECTION
▪
STAY AWAY FROM NSAIDS
•
Leukotrine modifiers
o Montelukast
▪ Use: asthma, prevents exercise induced bronchospasm
▪ SHOULD INSTRUCT PT TO TAKE 2 HR BEFORE EXERCISE
Chapter 18: Upper Respiratory Disorders
• Antitussives: Opioids
o Codeine (this could be cough syrup! There is a HIGH ABUSE rate)
▪ Use: FOR THAT DRY, NON-PRODUCTIVE COUGH
▪ SE: sedation, dizziness, constipation, respiratory depression
▪ INCREASE FIBER AND FLUID INTAKE
• Expectorants
o Guaifenesin (Mucinex)
▪ Use: for that PRODUCTVE COUGH, MUCUS FILLED
▪ SE: drowsiness, GI upset
▪ ACTION: reduces the viscosity of cough
▪ DRINK A LOT OF FLUIDS TO HELP LIQUIFY THOSE SECRETIONS
• Mucolytics
o Acetylcysteine
▪
•
ALSO USED AS AN ATIDOTE FOR
ACETAMIDOPHEN POISIONING!!!!!!!
Use: cystic fibrosis,
▪ Use in CAUTION with someone with asthma
▪ SE: dizziness, drowsiness, hypotension, tachycardia
▪ EXPECT THAT ROTTEN EGG SMELL!!!!
Decongestants
o Phenylephrine
o Pseudoephedrine
▪ Use: rhinitis (NASAL CONGESTION)
▪ SE: agitation, nervousness, palpitations
▪
•
IF YOU TAKE IT A LONG TIME AND GO OFF OF IT, YOU WILL GET THAT REBOUND
CONGESTION
Antihistamines
o Diphenhydramine (Benadryl)
o Loratadine
▪ Use: nasal congestion, mild allergic reactions, motion sickness
▪ SE: anticholinergic, constipation, urinary retention, SEDATION
• Nasal glucocorticoids
o Mometasone
▪ Use: rhinitis, nasal itching, runny nose
▪ (MOM HAS A STUFFY NOSE!)
Chapter 19: Medications Affecting Urinary Output
• Loop diuretics
o Furosemide (Lasix)
▪ Use: fluid retention caused by heart failure
▪ SE:
HYPOTENSION,
HYPONATREMIA,
HYPOKALEMIA,
OTOTOXICITY,
DEHYDRATION (VERY IMPORTANT!)
▪ TAKE IT IN THE AM, NOT THE MORNING SO THEY WONT BE WAKING UP TO
PEE!!!!!
▪ MONITOR ELECTROLYTE LEVELS
▪ EAT FOODS HIGH IN POTASSIUM
▪ WEIGH PATIENT DAILY!!!!!
• Thiazide diuretics
o Hydrochlorothiazide
▪ Use: fluid retention caused by heart failure, used in hypertension
▪ SE: dehydration, hypokalemia, hyperglycemia
• Potassium sparing diuretics
o Spironolactone
▪ Use: fluid retention caused by heart failure
▪ SE: HYPERKALEMIA, AMMENORRHEA, GYNOCYMASTIA
▪ NOT ELIMINATING THE POTASSIUM
▪ Contraindications: kidney disease
• Osmotic diuretics
o Mannitol
▪ Use: prevents kidney failure, DECREASES INTRACRANIAL PRESSURE
▪ (MAN I HAD THE WORST HEADACHE FROM ALL THE INTRACRANIAL PRESSURE
BUT MAN IT WENT AWAY WHEN I TOOK MANNITOL)
▪ SE: heart failure, pulmonary edema, rebound increased intracranial pressure
Chapter 20: Medications Affecting Blood Pressure
• ACE Inhibitors (ALL END IN –pril)
o Captopril
o Lisinopril
▪ Use: hypertension, heart failure, MI’s
▪ SE: COUGH, HYPERKALEMIA, ANGIOEDEMA (A-ANGIOEDEMA, C-COUGH, EELEVATED POSTASSIUM! HYPERKALEMIA), hypotension
▪ Want patient to change position slowly bc of orthostatic hypotension
▪ Want patient to monitor their BP
• Angiotensin 2 receptor Inhibitors (ALL END IN –sartan)
o Lorsartan
▪ Use: hypertension, heart failure, MI’s
▪ SE: ANGIOEDEMA, GI UPSET, HYPOTENSION
•
•
Calcium Channel blockers (END IN –ipine)
o Nifedipine
o Amlodipine
o Verapamil
o Diltiazem
▪ Use: angina, hypertension, cardiac dysrhythmias
▪ SE: hypotension, slow HR, peripheral edema, constipation
▪ SHOULD NOT DRINK GRAPE JUICE
▪ SHOULD MONITOR HR AND BLOOD PRESSURE
Beta blockers (END in –lol)
o Metoprolol
o Propranolol
o Atenolol
▪ Use: hypertension, angina, tachycardia, heart failure, MI’s
▪ SE: BRADYCARDIA, ORTHOSTATIC HYPOTENSION, HYPOTENSION, FATIGUE,
ERECTILE DYSFUNCTION (STAY AWAY FROM ED DRUGS)
▪ BRONCHOCONTRICTION IS A BIG SE IN PROPANOLOL!!!! DO
NOT LET PEOPLE WITH ASTHMA TAKE THIS!!!!!!!!! IMPORTANT
•
Medications for hypertensive crisis (Nitro)
o Nitroprusside
▪ Use: hypertensive crisis, MI’s
▪ SE: HYPOTENSION, CYANIDE POISONING
Chapter 21: Cardiac Glycosides and Heart Failure
• Cardiac glycosides
o Digoxin (SUPER IMPORTANT!!!!!!)
▪ Use: HEART FAILURE, V-FIB
▪ (MOM, DID YA GET UR PRECRIPTION FOR HEART FAILURE? YEAH I GOT MY
DIGOXIN)
▪ SE: DSYRHYTHMIAS, BRADYCARDIA
▪ KNOW THE SIGNS OF DIGOXIN TOXICITY! GI UPSET, FATIGUE, VISION CHANGES!
▪ WITHHOLD IF YOU HAVE A HR UNDER 60
▪ ALWAYS CHECK THE PULSE RATE FOR THE FULL MINUTE BEFORE GIVING
▪ MONITOR DIGIXIN LEVELS 0.5-2 (OVER 2 IS TOXIC)
▪ KEEP POTASSIUM LEVELS UP! INCREASE THE POTASSIUM RICH FOOD
▪ TREAT OVERDOSE WITH DIGIBINE/DIGOXIN IMMUNE FAB/ACTIVATED
CHARCOAL
• Adrenergic agonists
o Epinephrine
o Dopamine
▪ Use: cardiac arrest, asthma
▪ SE: hypertensive crisis, dysrhythmias
Chapter 22: Angina
• Nitrates
o Nitroglycerin
▪ Use: angina attack
▪ SE: HEADACHE!!!!!!! (VERY COMMON), ORTHOSTATIC HYPOTENSION, REFLEX
TACHYCARDIA
▪ Sublingual: IF YOU ARE HAVING CHEST PAIN, SIT DOWN, ADMINISTER
NITROGLYCERIN, WAIT 5 MINUTES, IF IT IS NOT GONE THEN CALL 911,
ADMINISTER ANOTHER TABLET, WAIT 5 MINUTES, TAKE ANOTHER IF IT HASN’T
SUBSIDED
▪ Patch/Transdermal: PLACE ON A HAIRLESS SPOT, ROTATE SITES, REMOVE OLD
PATCH, WEAR GLOVES
Chapter 24: Antilipemic Agents (Cholesterol Medications)
• HMG-CoA Reductase Inhibitors (END IN –statin)
o Atorvastatin
o Simvastatin
▪ Use: used to lower cholesterol, decreases LDL
▪ SE: HEPATOTOXICITY, MYOPATHY (muscle pain)
▪ ADMINISTER IN THE EVENING WITH A MEAL!!!!!! CHOLESTEROL IS SYNTHESIZED
AT NIGHT
▪ MONITOR LIVER FUNCTION
▪ AVOID ALCOHOL
• Bile-acid sequestrants
o Colesevelam
o Colestipol
▪ Use: used to lower cholesterol levels, decreases LDL
▪ SE: CONSTIPATION
▪ INCREASE FIBER AND FLUID INTAKE
▪ INTERFERES WITH FAT-SOLUBLE VITAMIN ABSORPTION
• Nicotinic acid, niacin
o Niacin
▪ Use: used to lower cholesterol, decreases LDL and RAISE HDL
▪ SE: FLUSHING OF THE FACE, HYPERGLYCEMIA, HEPATOXICITY, GI DISTRESS
▪ MONITOR LIVER FUNCTION
▪ MONITOR BLOOD GLUCOSE LEVELS
• Fibrates
o Gemfibrozil
o Fenofibrate
▪ Use: reduces triglycerides, increases HDL
▪ SE: GI DISTRESS, GALLSTONES, MYOPATHY (MUSCLE PAIN), HEPATOXICITY
▪ GIVE MEDICATION 30 MINS BEFORE BREAKFAST AND DINNER
Chapter 25: Medications Affecting Coagulation
• Anticoagulant
o Heparin
o Enoxaparin (LOW MOLECULAR WEIGHT HEPARIN)
▪ Use: PREVENTS NEW CLOTS!!!!! (DOES NOT BREAK UP EXISTING CLOTS)
▪ SE: bleeding, heparin-induced thrombocytopenia
▪ WHEN A PATIENT IS ON HEPARIN, WE MONITOR THE aPTT LEVELS
▪ ANTIDOTE: PROTAMINE
▪ LOOK FOR SIGNS OF BLEEDING! Black tarry stools, coffee ground emesis
• Oral anticoagulants
o Warfarin
▪ Use: PREVENTS CLOTS!!!!!
▪ SE: BLEEDING, GI upset, hepatitis
▪ MONITOR PT and INR LEVELS
• 2-3 therapeutic INR levels
▪ ANTIDOTE: VITAMIN K
▪ DON’T INCREASE YOUR INGESTION OF VITAMIN K FOODS! LEAFY GREENS
• Antiplatelets
o Aspirin
o
o
Abciximab
Clopidogrel
▪ Use: PREVENTS PLATELETS FROM CLUMPING
▪ SE: GI upset, BLEEDING, TINNITUS
▪ DO NOT GIVE ASPIRIN TO CHILDREN! REYES SYNDROME
▪ CONTRAINDICATED IN PEOPLE WITH BLEEDING DISORDERS
• Thrombolytics (END IN –plase) (IF YOU HAVE COME TO BREAK UP A CLOT, YOU’VE COME TO THE
RIGHT PLACE)
o Alteplase
▪ Use: BREAKS UP CLOTS
▪ SE: BLEEDING!!!!!!
▪ CONTRAINDICATED IN PEOPLE WITH A HEMORRHAGIC STROKE, SEVERE
HYPERTENSION, SURGERY
▪ Closely monitor labs and vital signs
▪ Stay away from vein punctures
Chapter 26: Growth Factors
• Erythropoietic growth factors
o Epoetin alpha
▪ Use: anemia, increases those RBCs
▪ SE: HYPERTENSION
▪ DO NOT AGITATE THE VIAL
▪ MONITOR BP
▪ Ensure they have sufficient iron levels
• Leukopoietic growth factors
o Filgrastim
▪ Use: NEUTROPENIA
▪ SE: BONE PAIN, LEUKOCYTOSIS (TOO MANY WBCS), spleen rupture
▪ MONITOR CBC LEVELS TWICE A WEEK
▪ DO NOT AGITATE THE VIAL
Chapter 27: Blood and Blood Products
• Get baseline vitals before giving blood
• Get the patient to sign consent
• Get the vitals before beginning the transfusion
• 20-guage or bigger IV catheter
• 0.9% sodium chloride NORMAL SALINE ONLY
• ALWAYS have 2 nurses to CONFIRM blood
• CAN ONLY HANG 4 HOURS
ADVERSE REACTIONS TO BLOOD:
• STOP THE TRANSFUSION
• DISCONNECT THE TUBING
• HOOK TO NORMAL SALINE
• CALL THE PROVIDER
• Obtain a urine specimen to determine RBC hemolysis
SYMPTOMS:
• Fever
• Low back pain
• Anaphylaxis
• Sepsis
• Tachycardia
• Dyspnea
• Hypertension
Chapter 28: Peptic Ulcer Disease
• Histamine-receptor antagonists (END IN –tidine)
o Ranitidine
o Climetidine
▪ Use: peptic ulcer disease, GERD
▪ SE: increases the risk or bacteria
▪ DO NOT OVEREAT
▪ REDUCE STRESS LEVEL
▪ AVOID NSAIDS
• Proton pump inhibitors (END IN –prazole)
o Omeprazole
o Pantoprazole
▪ Use: peptic ulcer disease, GERD
▪ SE: GI UPSET, OSTEOPOROSIS
• Muscosal protectant (PROTECTIVE LINING OVER THE ULCERS)
o Sucralfate
▪ Use: stomach ulcers
▪ SE: CONSTIPATION!!!!!!!!!!!!!
▪ Take 1 hour before meals and at bedtime!!!!!!
▪ INCREASE FIBER AND FLUID INTAKE
• Antacids
o Magnesium hydroxide (SE: DIARRHEA)
o Aluminum hydroxide (SE: CONSTIPATION)
o Calcium carbonate (SE: CONSTIPATION)
▪ Use: peptic ulcer disease
▪ DO NOT TAKE WITH OTHER MEDICATIONS
• Prostaglandins
o Misoprostol
▪ Use: clients on LONG-TERM NSAIDS to prevent gastric ulcers
▪ CANNOT!!!!! USE!!!!!! IN!!!! PREGNANT WOMEN!!!!!!!!!!!
▪ Must obtain a pregnancy test before giving this!!!!!!!
Chapter 29: Gastrointestinal Disorders
• Laxatives
o Psyllium
o Docustate sodium
o Bisacodyl
o Magnesium hydroxide
▪ Use: SOFTEN STOOL
▪ SE: GI upset, rectal burning sensation, toxic magnesium levels
▪ CANNOT BE USED IF THEY HAVE A BOWEL OBSTRUCTION
▪ INCREASE EXERCISE
• Antidiarrheals
o Loparamide
o Diphenoxylate plus atropine
▪ Use: stop diarrhea
▪ SE: constipation, drowsiness, anticholinergic effects
• Prokinetic agents
o Metoclopramide
▪ Use: nausea, vomiting
▪
SE: EXTRAPYRAMIDAL EFFECTS (restlessness, anxiety, dyskinesia, tremors,
rigity), sedation, diarrhea
Chapter 30: Vitamins, Minerals, and Supplements
• Iron preparations
o Ferrous sulfate
▪ Use: iron deficiency
▪ SE: GI UPSET, TEETH STAINING, STOOLS WILL BE DARK GREEN/BLACK
▪ VITAMIN C INCREASES ABSORPTION OF IRON
▪ INCREASE FLUID AND FIBER TO PREVENT CONSTIPATION
▪ Increase intake of iron rich foods
• Vitamin B12
o Vitamin B12
▪ Use: metablastic anemia
• Folic Acids
o Folic acid
▪ Use: pregnant women for neural tubes for fetus, alcohol use disorder
▪ NEVER GIVE FOLIC ACID TO SOMEONE LACKING B12
• Potassium
o Potassium
▪ Use: hypokalemia, use of diuretics
▪ SE: hyperkalemia
▪ NEVER GIVE A RAPID INFUSION OF POTASSIUM
• Magnesium
o Magnesium
▪ Use: hypomagnesima, preterm labor
• Herbal Supplements
o Black cohash
▪ Use: menopause
o Garlic, ginger, ginko biloba
▪ CAN INCREASE BLEEDING!!!!!
o St. John’s Wart
▪ Use: mild depression
o Valerian
▪ Use: anxiety
Chapter 31: Medications Affecting the Reproductive Tract
• Estrogens
o Conjugated equine estrogens
o Estradiol
▪ Use: birth control, menopause
▪ SE: thrombolytic events, weight gain, edema,
▪ CONTRAINDICATED IN THESE PATIENTS: SMOKERS!!!!! HYPERTENSION!!!!
PATIENTS AT HIGH RISK FOR EMBOLIC EVENTS!!!!!!!!
• Progesterone
o Medroxyprogesterone
▪ Use: birth control, maintain pregnancy
▪ SE: thrombolytic events, break-through bleeding, breast cancer
▪ PATIENTS SHOULD DELAY CONCEPTION FOR 3 MONTHS
▪ CONTRAINDICATED IN PATIENTS WHO ARE AT RISK FOR EMBOLIC EVENTS!!!!!!!!!
• Androgens
o Testosterone
▪ Use: hypogonadism, delayed puberty in boys, post-menopausal breast cancer
•
•
•
▪ SE: acne, EPIPHYSEAL CLOSURE
▪ HIGH ABUSE POTENTIAL
▪ CONTRAINDICATED IN PEOPLE WITH PROSTATE CANCER
5-Alpha reductase inhibitors
o Finasteride
▪ Use: BPH, male pattern baldness
▪ SE: ED, gynecomastia
▪ PREGNANT WOMEN SHOULD NEVER HANDLE THIS MEDICATION!!!!!!!!
Alpa1-adrenergic antagonists
o Tamsulosin
▪ Use: BPH
▪ SE: hypotension, nasal congestion, sleepiness, faintness
▪ HOLD THE MEDICATION BEFORE CATARACTS SURGERY!!!! FLOPPY IRIS
SYNDROME
Phosphodiesterase type 5 inhibitors
o Sildenafil
▪ Use: erectile dysfunction
▪ SE: HYPOTENSION!!!! Priapism, INCREASED RISK OF MI!!!!!
▪ SHOULD NOT TAKE WITH ANY OTHER NITRATES!!!!!!!!!!!!!!
KNOW
THIS!!!!!!!!!!!!!!!!!!!!!!!
ISOBORBIDE!!!!!!!!
NITROGLYCERIN!!!!!
Chapter 32: Medications Affecting Labor and Delivery
• Uterine stimulants
o Oxytocin
▪ Use: INDUCES LABOR
▪ SE: painful contractions, uterine rupture
▪ CLOSELY MONITOR CONTRACTIONS
▪ LESS THAN 60 SECONDS, 2-3 MINUTES APART!!!! If it is more, DISCONTINUE and
notify provider
▪ Monitor mother and fetus
• Tocolytic medications
o Terbutaline
▪ Use: prevent preterm labor
▪ SE: tachycardia, angina
▪ Contraindicated: GESTATION OF 34 WEEKS OR GREATER, or DIALATION of 6 cm
or greater
• Opioid analgesics
o Fentanyl
▪ Use: pain of birth
▪ SE: dry mouth, tachycardia, sedation, nausea, vomiting
▪ DELIVERY MUST BE WITHIN 1-4 HOURS NOW
Chapter 33: Connective Tissue Disorders
o Methotrexate
▪ Use: rheumatoid arthritis
▪ SE: INFECTION!!!! Because of that immunosuppression, hepatotoxicity, bone
marrow suppression
o Cyclosporine
▪ Use: rheumatoid arthritis
▪ SE: infection!!!! Hepatotoxicity, nephrotoxicity
Chapter 34: Bone Disorders
• Calcium supplements
o
•
•
Calcium citrate
▪ Use: hypocalcemia, pregnant women/breastfeeding
▪ SE: hypercalcemia
▪ NEED ADEQUATE VITAMIN D FOR ABSORPTION
Selective estrogen receptor modulator
o Raloxifene
▪ Use: osteoporosis
▪ (I CAN RELAX NOW THAT I AM TAKING RALOXIFENE FOR MY OSTEOPOROSIS)
▪ SE: DVT, hot flashes
▪ ENCOURAGE PATIENT TO INCREASE IN CALCIUM
▪ ENCOURAGE WEIGHT BARING EXERCISE
Bisphosphonates (END IN –dronate)
o Aldendronate
▪ Use: OSTEOPOROSIS
▪ SE: ESOPHAGITIS!!!!!!!!!!
▪ WANT PATIENT TO SIT UP FOR 30 MINUTES WHILE TAKING TO
PREVENT ESOPHAGITIS!!!!!!!!!!
▪ TAKE IN AM
▪ DRINK 8 oz OF WATER
•
Calcitonin
o Calcitonin salmon
▪ Use: osteoporosis
▪ SE: gi upset, nasal irritation, dryness
Chapter 35: Nonopioid Analgesics
• NSAIDS
o Aspirin (TINNITUS)
o Ibuprofen
o Naproxen
▪ Use: pain relief
▪ SE: GI UPSET, GI BLEEDING,
▪ STAY AWAY IF THEY ARE BABIES BC OF REYES SYNDROME!!!!
• Acetaminophen
o Use: pain relief
o SE: HEPATOTOXICITY!!!!!!
o MAX OF 4 G PER DAY!!!!!!!!!!!!!!! NO MORE
o ACETYLCYSTINE is ANTIDOTE
Chapter 36: Opioid Agonists and Antagonists
• Opioid agonists
o Morphine
o Fentanyl
o Codeine
▪ Use: pain relief
▪ SE: RESPIRATORY DEPRESSION!!!! SEDATION!! CONSTIPATION!!! GI UPSET,
URINARY RETENTION, HYPOTENSION
▪ Naloxone is ANTIDOTE
▪ MONITOR RESPIRATORY STATUS, BP
▪ MONITOR AROUND THE CLOCK FOR CANCER PAIN
▪ INCREASE FIBER AND FLUID INTAKE
• Opioid Antagonist
o
Naloxone
▪ Use: antidote for opioid
▪ SE: HYPERTENSION, ANGINA, AGITATION, TACYCARDIA, TACYAPNEA, GI UPSET
▪ BETTER BE READY FOR THEM TO COME UP SWINGING
▪ MONITOR THEIR PAIN
Chapter 38: Miscellaneous Pain Medications
• Migraine Medications
o Ergotamine
▪ Use: acute attacks of migraine headache
▪ SE: Hypertension, GI upset, muscle pain, numbness, tingling
▪ SHOULD LAY DOWN IN A DARK QUIET PLACE
▪ AVOID TYRAMINE RICH FOODS
▪ AVOID ALCOHOL
▪ ONLY TAKE WHEN YOU ARE EXPERIENCING A HEADACHE! Taking prophylactically
can lead to dependence
o Sumatriptan
▪ Use: acute attacks of migraines
▪ SE: Angina, dizziness, warm-tingling sensation
▪ SHOULD LAY DOWN IN A DARK QUIET PLACE
▪ AVOID TYRAMINE RICH FOODS
▪ AVOID ALCOHOL
• Local anesthetics
o Lidocaine
▪ Use: pain management for dental procedures, surgical procedures, labor and
delivery
▪ SE: Hypotension, bradycardia, prolonged labor, allergic reactions, spinal
headache, SEIZURES
▪ CAN BE USED FOR TOPICAL ADMINISTRATION (pain at an IV injection site)
▪ WANT TO APPLY THE LIDOCAINE 1 HOUR BEFORE THE PROCEDURE, then cover
with an occlusive dressing
Chapter 39: Diabetes Mellitus
REMEMBER: CLOUDY (intermediate-acting; NPH) to CLEAR (short-acting; R), then CLEAR (short-acting;
R) TO CLOUDY (intermediate-acting; NPH)
• Insulins
o regular insulin (Humulin R) –
▪ SHORT-ACTING
▪ ONSET: 0.5 to 1 hour
▪ PEAK: 1 to 5 hour
▪ DURATION: 6 to 10 hour
▪ INSULIN OF CHOICE IN ACUTE SITUATIONS (SUCH AS DKA, severe infection, and
surgical procedures)
▪ Use: lower blood glucose, but the dose must be individualized according to
blood glucose levels
▪ SE: HYPOGLYCEMIA, tachycardia, sweating, shaking, headache
▪ Contraindications: hypoglycemia because of risk of brain damage
▪ ONLY insulin that can be given intravenously (IV)
▪ Approved for use in external insulin pumps
o isophane insulin (NPH insulin) –
▪ INTERMEDIATE-ACTING
▪ ONSET: 1 to 2 hour
▪ PEAK: 6 to 14 hour
▪ DURATION: 16 to 24 hour
▪
•
•
•
•
Use: lower blood glucose, but the dose must be individualized according to
blood glucose levels
▪ SE: HYPOGLYCEMIA, tachycardia, sweating, shaking, headache
▪ Often used for long-term therapy; for most patients, given in combination with
a short-acting insulin
▪ Provides a more consistent regulation of blood glucose levels
▪ CLOUDY SOLUTION; REMEMBER: roll in hands before administering, DO NOT
shake
o linspro insulin OR glulisine insulin OR aspart insulin –
▪ RAPID-ACTING (FASTEST ACTING)
▪ ONSET: 15 to 30 minute
▪ PEAK: 0.5 to 2.5 hour
▪ DURATION: 3 to 6 hour
▪ Use: lower blood glucose, but the dose must be individualized according to
blood glucose levels
▪ SE: HYPOGLYCEMIA, tachycardia, sweating, shaking, headache
▪ MAKE SURE THEIR FOOD IS RIGHT IS FRONT OF THEM
o glargine insulin (Lantis) OR detemir insulin (Levamir) –
▪ LONG-ACTING
▪ ONSET: 70 minute
▪ PEAK: NONE
▪ DURATION: 24 hour
▪ Use: lower blood glucose, but the dose must be individualized according to
blood glucose levels
▪ SE: HYPOGLYCEMIA, tachycardia, sweating, shaking, headache
▪ REMEMBER: CANNOT EVER mix Lantis or Levamir with ANY OTHER INSULIN
▪ REMEMBER: CANNOT be used in external insulin pump (AKA a subcutaneous
pump)
Sulfonylureas
o Glyburide
o Glipizide
▪ Use: type 2 diabetes
▪ SE: HYPOGLYCEMIA, photosensitivity, GI upset
▪ Take this medication 30 minutes before a meal
▪ Patient should wear sunscreen because of the photosensitivity
Meglitinides
o Repaglinide
▪ Use: type 2 diabetes
▪ SE: HYPOGLYCEMIA, angina
▪ Take 3 times a day, eat within 30 minutes of the dose
Biguinides
o Metformin
▪ Use: type 2 diabetes
▪ SE: GI upset, B12 deficiency, metallic taste, LACTIC ACIDOSIS
▪ Take this with a meal
▪ DO NOT drink alcohol
▪ Will probably have to DISCONTINUE dose if they have an upcoming procedure
or anything with contrasting dye
Alpha glucoside inhibitors
o Acarbose
▪ Use: type 2 diabetes
▪ SE: GI upset, hepatotoxicity, anemia
▪
•
Taken with the 1st bite of food
Glucagon
o Glucagon
▪ Use: SEVERE HYPOGLYCEMIA, insulin overdose
▪ Provide IM or IV
▪ Provide food as soon as the patient is able to safely swallow
▪ SE: GI upset
Chapter 40: Endocrine Disorders
• Thyroid hormone
o Levothyroxine
▪ Use: HYPOTHYROIDISM
▪ SE: GI upset, anxiety, heat intolerance, weight loss (HYPERTHYROID)
▪ Take in the morning with a full glass of water
▪ LIFE-LONG TREATMENT
• Antithyroid hormone
o Propylthiouracil
▪ Use: HYPERTHYROIDISM, preparation for a thyroidectomy
▪ SE: lethargy, weight gain, depression (HYPOTHYROID)
▪ Monitor the liver function
o Radioactive iodine
▪ Use: HYPERTHYROIDISM
▪ SE: radiation sickness, bone marrow suppression, HYPOTHYROID
o Strong iodine solution
▪ Use: HYPERTHYROIDISM
▪ SE: Iodism (metallic taste, stomatitis, sore teeth and gums, frontal headache, skin
rash), hypersensitivity
▪ Increase fluid intake
▪ Can mix the solution to improve taste
▪ Avoid food high in iodine (salt/seafood)
• Anterior pituitary hormones/growth hormones
o Somatropin
▪ Use: stimulates growth
▪ SE: hyperglycemia
▪ Administer via IM or SUBQ
▪ STOP TREATMENT PRIOR TO EPIPHYSEAL CLOSURE!!!!!! MONITOR BRONE
GROWTH!!!!!!!!
• Antidiuretic hormone
o Vasopressin
o Desmopressin
▪ Use: DIABETES INSIPIDUS (EXCESSIVE THIRST! EXCESSIVE URINATION)
▪ SE: headache
▪ Reduce their fluid intake during therapy
• Adrenal hormone replacement
o Hydrocortisone
▪ Use: Addison’s disease
▪ SE: OSTEOPOROSIS, PEPTIC ULCERS, INFECTION, WEIGHT GAIN
▪ ALWAYS TAPER OFF!!!!
▪ May increase dose in signs of stress
Chapter 42: Chemotherapy Agents
• Antitumor antibiotics
o Doxorubicin
▪
▪
Use: treating solid tumors
SE: GI upset, alopecia, bone marrow suppression, cardiac toxicity, RED
DISCOLORATION OF URINE, SWEAT, TEARS
(The BALD DOCEN is SICK because of his TUMOR and he is crying RED TEARS)
▪
Antimitotics
o Vincristine
▪ Use: tumors and cancer
▪ DOES NOT CAUSE BONE MARROW SUPPRESSION
▪ SE: phlebitis at the IV site, peripheral neuropathy (weakness, parathesia), severe
tissue damage, GI upset, alopecia
▪ (If you drink too much Vino you will get cancer and won’t be able to feel your
arms and legs)
• Alkylating agents
o Cyclophosphamide
▪ Use: tumors and cancer
▪ SE: bone marrow suppression, GI upset, alopecia, ACUTE HEMORRHAGIC
CYSTITIS
▪ Increase fluid
▪ LOOK for BLOOD IN URINE
▪ ADMINISTER Uroprotectant agent!!!! MESNA
▪ (Cy wants to go CYCLING but she is afraid her cancer will make her have CYSTITIS
and she will PEE BLOOD)
• Noncytotoxic chemotherapy agents
o Leuprolide
▪ Use: PROSTATE CANCER
▪ SE: hot flashes, gynecomastia, decreased libido, decreased bone density
▪ (Leuprolide makes your libido leuk-warm because of the nasty side effects;
gynecomastia and hot flashes! LIKE A WOMAN)
o Tamoxifen
▪ Use: BREAST CANCER
▪ SE: hot flashes, GI upset, hypercalcemia, INCREASED RISK OF ENDOMETRIAL
CANCER
• Biologic response modifiers
o Interferon alfa-2b
▪ Use: cancers and viral infections
▪ SE: FLU-LIKE symptoms, bone marrow suppression, cardiac suppression, GI
upset, alopecia, NEUROPATHY, DEPRESSION, MUSCLE ACHES
▪ (Interferon INTERFERES with CANCER BUT gives you flu-like symptoms)
Chapter 43: Principles of Antimicrobial Therapy
• ALWAYS do a CULTURE before starting any antibiotics
• NEED TO FINISH the ENTIRE course of antibiotic therapy
Chapter 44: Antibiotics Affecting the Bacterial Cell Wall
• Penicillins (END in –cillin)
o Penicillin-G
o Amoxicillin
▪ Use: strep, meningitis, endocartitis, any bacterial infection
▪ SE: POSSIBLE ALLERGIC REACTION! GI upset, renal toxicity
▪ CHECK to see if they have any reaction to penicillins or cephalosporins
• Cephalosporins (BEGIN with –ceph/cef)
o Cephalexin
o Cefazolin
o Ceftriaxone
•
▪ Use: any bacterial infection
▪ SE: GI upset, ALLERGIC REACTION, bleeding, SUPERINFECTION!!!!
▪ (C. diff or yeast infection; superinfection)
▪ CHECK to see if they have any reaction to penicillins or cephalosporins
• Carbapenems
o Imipenem-cilastatin
▪ Use: serious bacterial infections
▪ SE: GI upset, rash, SUPERINFECTION
• Other inhibitors of cell wall synthesis
o Vancomycin
▪ Use: serious infection, C. DIFF infections
▪ SE: OTOTOXICITY, RENAL TOXICITY!!!!!!!
▪ *** MONITOR TROUGH LEVELS!!!!!!!!!!!!!!!!!!!
▪ Dose may need to be adjusted based on creatinine levels
▪ (Someone is in a VAN and THEY TURN THE MUSIC UP TOO LOUD and they give
themselves OTOTOXICITY)
Chapter 45: Antibiotics Affecting Protein Synthesis
• Tetracyclines (END in –cycline)
o Tetracycline
o Doxycycline
▪ Use: bacterial infections, lyme disease, rocky mountain spotted fever
▪ SE: GI upset, TOOTH DISCOLORATION, hepatotoxicity, photosensitivity, dizziness
▪ NEVER GIVE TO PREGNANT WOMEN OR KIDS UNDER 2 YEARS OLD!!!!!!!
▪ Use another method of BC
▪ Take with a full glass of water
▪ DAIRY PRODUCTS CAN DECREASE ABSORPTION!!!!!!!
• Macrolides (END in –mycin)
o Erythromycin
▪ Use: bacterial infection
▪ SE: GI upset, OTOTOXICITY, PROLONGED QT intervals
• Aminoglycosides (END in –mycin)
o Gentamicin
▪ Use: SERIOUS bacterial infections
▪ SE: OTOTOXICITY, NEPROTOXICITY, VERTIGO, ATAXIA
▪ Monitor for tinnitus and hearing loss
▪ DRAW THE PEAK AND TROUGH!!!!!!!!!!!!!!!!
Chapter 46: Urinary Tract Infections
• Sulfonamides
o Trimethoprim-sulfamethoxazole
▪ Use: UTI’s
▪ SE: GI upset, blood dyscrasias, crystalluria, kernicterus, hyperkalemia,
hypersenisitivity
▪ INCREASE FLUID INTAKE TO PREVENT CRYSTALLURIA
• Urinary tract antiseptic
o Nitrofurantoin
▪ Use: UTI
▪ SE: GI upset, hypersensitivity, blood dyscrasias, brown urine, peripheral
neuropathy
• Fluoroquinolones (END in –floxacin)
o Ciprofloxacin
o Oflaxacin
o Levofloxacin
▪ Use: UTI
▪ SE: GI upset, photosensitivity, SUPERINFECTION, ACHILLES TENDON RUPTURE
• Urinary tract analgesic
o Phenazopyridine (AZO)
▪ Use: UTI SYMPTOMS, PAIN, URGENCY
▪ SE: ORANGE-RED URINE!!!!!!!!!!
Chapter 47: Tuberculosis Medications
• USUALLY ON THESE FOR 6-12 MONTHS
• Antituberculosis
o Isoniazid (SE: Neuropathy!!!!)
o Rifapentine (SE: ORANGE-COLORED SECRETIONS)
o Pyrazinamide
o Ethambutol (SE: CHANGES IN VISION)
▪ Use: tuberculosis
▪ SE: HEPATOTOXICITY!!!!!!!!!!!!!!!
▪ Patient needs 3 negative sputum samples to be considered free of TB
▪ Patient will have to wear an N95 mask
▪ No alcohol for the full treatment
• Antiprotazoal
o Metronidazole
▪ Use: TB, protazoans
▪ SE: GI upset, METALLIC TASTE!, DARK URINE!, dizziness, headache
▪ PATIENT SHOULD NOT DRINK ALCOHOL
▪ (someone’s car broke down and she’s taking the METRO and she has this
METALLIC TATSE in her mouth and when she uses the restroom her pee is DARK!
Now she is like “oh great and I can’t even have a drink after this)
• Antifungals
o Amphoteracin B
o Ketoconazole
▪ Use: fungal infections
▪ SE: HEPATOTOXICITY, GI USPET, BONE MARROW SUPPRESSION,
NEPROTOXICITY, PHELBITIS
▪ DO a TEST DOSE 1st
Chapter 48: Viral Infections, HIV, and AIDs
▪ Antivirals (END in –vir)
o Acyclovir
o Ganciclovir
▪ Use: VIRUSES, HERPES, VARICELLA
▪ SE: phlebitis, GI upset, nephrotoxicity, gingival hyperplasia
▪ THESE MEDS DO NOT CURE CONDITIONS! THEY SUPPRESS THE VIRUS
VERSION 7
ATI PHARMACOLOGY COMPLTE SOLUTION
1. A nurse is caring for a client with many different medications who is newly prescribed
acetazolamide. What medications can interact with acetazolamide?
Answer:
• High-dose aspirin (metabolic acidosis)
• Quinidine (can increase risk of toxic effects)
o Instruct client to notify provider of concurrent use and to watch for indications of toxicity, such
as decreased heart rate
• Lithium (decrease blood levels)
o Teach clients to watch for increased indications of mania. Monitor lithium levels regularly
• Phenytoin (increase osteomalacia)
o Teach clients to watch for bone pain or weakness and report symptoms to provider
• Sodium bicarbonate (increases risk of kidney stones)
o Question clients about use of sodium bicarbonate and other OTC antacids
2. A nurse is preparing to administer ipratropium by metered dose inhaler. What adverse effects
should the nurse instruct the client to monitor for?
Answer:
• Local anticholinergic effects (dry mouth, hoarseness)
o Advise client to sip fluids and suck on sugar-free hard candies to control dry mouth
3. A client has a new prescription for salmeterol. The nurse is teaching the client about adverse
effects of the medication. What instructions should the nurse include in thus education?
Answer:
• Tachycardia, angina
o Advise client to observe for chest, jaw or arm pain/palpitations and to notify provider if they
occur
o Instruct to check pulse and to report an increase of greater than 20-30/bpm
o Advise to avoid caffeine
o Dosage might need to be reduced
• Tremors
o Usually resolve with continued medication use
o Dosage might need to be reduced
4. A nurse is caring for a client prescribed the inhaled glucocorticoid beclomethasone (QVAR) for
the treatment of asthma. What is a potential adverse effect of this medication and what are two
(2) teaching points to discuss to address these adverse effects?
Answer: • Difficulty speaking, hoarseness, candidiasis
o Advise client to rinse mouth or gargle with water after use
o Advise client to monitor for redness, sores, or white patches and to report to provider if they
occur. Treat candidiasis with nystatin oral suspension
5. A client has a new prescription for an albuterol inhaler and a beclomethasone inhaler. What
instructions should the nurse include concerning use of these inhalers?
Answer:
• Advise client to inhale the beta2-agonist (albuterol) BEFORE inhaling the glucocorticoid
(beclomethasone). The beta2-agonist promotes bronchodilation and enhances absorption of the
glucocorticoid
6. A nurse is administering gemfibrozil to a client with elevated cholesterol. Identify two (2)
adverse effects related to this medication.
Answer:
• GI distress
• Gallstones
o Advise to observe for indications of gallbladder disease ( RUQ aches, pain, fat intolerance,
bloating)
o Notify provider provider if manifestations occur
• Myopathy (muscle tenderness, pain)
o Obtain baseline CK level, monitor periodically
o Monitor for muscle aches, pain, tenderness, and notify provider if adverse effects occur
o Stop medication if CK levels are elevated
• Hepatotoxicity
o Obtain baseline LFTs, monitor periodically
o Advise to observe for indications of liver dysfunction (anorexia, vomiting, nausea, jaundice),
notify provider if manifestations occur
o Stop medication if LFTs are abnormal
7. A nurse is teaching a client who has a new prescription for alprazolam. What instructions
should the nurse include?
Answer:
• Advise client to take medication as prescribed and to avoid abrupt discontinuation of treatment
to prevent withdrawal manifestations. Do not change the dosage or frequency without prior
approval of prescriber
• When discontinuing benzodiazepines that have been taken regularly for long periods and in
higher doses, taper the dose over several weeks
• Administer at bedtime if possible due to sedation
• Advise to swallow sustained-release tablets, avoid chewing/crushing
• Inform client about possible development of dependency during/after treatment and to notify if
indications of withdrawal occur
• Advise to keep benzodiazepines in a secure place due to their potential abuse
8. A nurse is administering a unit of packed red blood cells (PRBCs) to a client. What symptoms
would indicate circulatory overload? Name three (3) clinical manifestations of circulatory
overload. What are three (3) interventions the nurse can take action on if overload occurs?
Answer:
• Infiltration
o Pallor, local swelling at the sire, decreased skin temperature around the site, damp dressing,
slowed infiltration
• Stop infusion
• Elevate extremity
• Encourage active ROM
• Apply cold or warm compress depending on type of solution that infiltrated the tissue
• Check with provider to determine whether the client still needs IV therapy. If so, restart the
infusion PROXIMAL to the sire or in another extremity
• Phlebitis/thrombophlebitis
o Edema, throbbing burning, pain at the site, increased skin temperature, erythema, red line up
the arm with palpable band at vein site, slowed infusion
• Promptly discontinue infusion and remove catheter
• Elevate extremity
• Apply cold compress to minimize the flood of blood, then apply a warm compress to increase
circulation
• Check with provider to determine whether the client still need IV therapy. If so, restart the
infusion PROXIMAL to the site or in another extremity
• Obtain a specimen for culture at the sire and prepare the catheter for culture if drainage is
present
• Cellulitis
o Pain, warmth, edema, induration, red streaking, fever, chills, malaise
• Promptly discontinue infusion and remove catheter
• Elevate extremity
• Apply warm compress 3-4x/day
• Obtain specimen for culture at the site and prepare the catheter for culture if drainage is present
• Administer: antibiotics, analgesics, antipyretics
9. A nurse is caring for a client who has a new prescription for raloxifene. What are
contraindications for this medication that the nurse should discuss with the client?
Answer:
• Pregnancy risk category B
• Use in older adults can cause antiadrenergic effects (impotence) and CNS effects (confusion)
• H2-receptor antagonists decrease gastric acidity, which promotes bacterial colonization of the
stomach and the respiratory tract. Use cautiously in clients who are at a high risk for pneumonia,
including clients who have COPD
10. 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?
Answer:
• Dysrhythmias, cardiotoxicity
• GI effects: anorexia (usually 1st manifestation), nausea, vomiting, abdominal pain
• CNS effects: fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white
halos around objects)