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NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES Created by Dare Domico, RN, DSN Revised by Brenda Rowe.

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Presentation on theme: "NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES Created by Dare Domico, RN, DSN Revised by Brenda Rowe."— Presentation transcript:

1 NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES Created by Dare Domico, RN, DSN Revised by Brenda Rowe

2 Answering Pharmacology Questions  If familiar with the medication, use nursing knowledge to answer  Will identify the generic and the trade name  Form a relationship between medication and medical diagnosis  Determine the classification of the medication; will assist with action and side effects

3 Answering Pharmacology Questions  Recognize side effects associated with classification and relate nursing interventions  Learn meds in a classification by commonalities in their names (bronchodialators = “line”).  Use medication name to determine action (Lopressor =lo to lower and presser for pressure)  Use calculator on computer

4 What are the ---  “pril”  “lol”

5 Answering Pharmacology Questions Points to Remember  Do not take antacid with medications  Do not crush enteric-coated & sustained release tablets  Capsules should not be opened  The nurse never adjust or change a medication dose or abruptly stop medication  Avoid alcohol and smoking  Question (and hold) medications if the order is unclear, or dose is not a normal one.

6 Answering Pharmacology Questions  Trough level is lowest level of drug plasma concentration; draw prior to dose. Used with drugs that are toxic.

7 Nursing Priority  The nurse’s responsibility in administering medications is influenced by a) nursing guidelines for safe administration, b) pharmacologic implications of the medication, & aspects of medication administration.  The nurse is legally responsible for the medications administered, even when the medication is administered according to a physicians orders.

8 Practice Question Orally administered levothyroxine (Synthroid) 50 units daily is prescribed for a client with hypothyroidism. The nurse provides medication instructions to the client and tells the client to take the medication  1. Just after breakfast  2. With a snack at 3 PM  3. In the morning on an empty stomach  4. With food

9 Practice Question A client is prescribed lisinopril (Zestril) for treatment of hypertension. He asks a nurse about possible adverse effects. The nurse should teach him about which of the following common adverse effects of angiotensin converting enzyme (ACE) inhibitors? Select all that apply  1. Constipation  2. Dizziness  3. Headache  4. Hyperglycemia  5. Hypotension  6. Impotence

10 Sample question An adult client with Hodgkin’s disease who weighs 145 lb is to receive vincristine (Oncovin) 25 mcg/kg IV What is the correct dose in micrograms that the client should receive?

11  1 st weight from lb to kg  145 lb = 65.8 kg  Multiply weight in kg by number of micrograms desired per kg  1645 mcg

12 Sample question The nurse is verifying whether to give a medication to a client. What should the nurse check first?  1. Client’s name  2. Expiration date of the drug.  3. Route of delivery.  4. Chart to see whether the drug was ordered.

13 Sample question  The nurse admits a patient with a fractured femur from the ER. The patient received morphine 10 mg SQ five hours before. The patient is scheduled for surgery and no further pain orders have been written. The patient is complaining of severe pain and the physician can not be reached. The nurse administers 5 mg morphine SQ and the patient is comfortable within 30 minutes. What is the best interpretation of the nurse’s action?

14 Sample question  1. The nurse made an appropriate nursing judgment by giving a lesser amount of the drug.  2. The nurse acted correctly because the client was in pain and the doctor could not be contacted.  3. The drug had been previously ordered; therefore the nurse's actions were correct.  4. The nurse is legally liable for administering a medication with an order.

15  Generic Name  Brand Name  Therapeutic drug class (Classification)  Action on body (therapeutic actions)  Indications  Contraindications  Dosage  Adverse effects  Drug-food interaction  Nursing Considerations  Assessment  Implementation  Teaching points

16 Chemotherapeutic Agents  Anti-infective Antibiotics Antiviral Antifungal Antiprotozoal  Anthelmintic  Antineoplastic

17 Anti-infective  Toxic to infective agent  No effect on human host cells  Immune system activity needed  Adverse effects Toxic effects on kidney, GI tract, & nervous system. Hypersensitivity and super infections

18 Antibiotics  Chemicals that inhibit specific bacteria  Major classes of antibiotics (aminoglycosides, cephalosporins, fluoroquinoiones, lincosamides, macrolides, monobactams, penicillins and penicillinase-resistant drugs, sulfonamides, tetracyclines, and the disease- specific antimycobacterials and leprostatic drugs.

19 Aminoglycosides  Mycin drugs  Renal and hepatic toxicity  Avoid with herpes and parkinsonism  Avoid with strong diuretics

20 Cephalosporin  Penicillin like

21 Antineoplastic Agents  Akylating Agents  Antimetabolites  Antineoplastic antibiotics  Mitotic inhibitors  Hormones and hormone modulators

22 Anti-inflamatory  NSAIDS  Antigout

23 Immune Modulators  Immune stimulants Interferons Interleukins T/B cell modulators  Immune suppressants T/B cell suppressors Monoclonal antibodies Vaccines  Bacterial vaccines  Toxoids  Viral vaccines  Immune sera Antitoxins.Antiveniom

24 Drugs Acting on CNS  Anxiolytic and Hypnotic Agents  Antidepressant Agents  Psychotropic Agents  Antiepileptic Agents  Antiparkinsonism Agents  Muscle Relaxants  Narcotics & Antimigraine Agents  General & local Anesthetic Agents  Neuromuscular Junction Blocking Agents

25 Antiparkinsonism Agents  Anticholinergics Oppose the effects of acetylcholine at receptor sites to normalize the acetylcholine-dopamine imbalance,  Dopaminergics Increase the effects of dopamine at receptor sites.

26 GI drugs  Antacids  Laxative  H2 histamine antagonist

27 Adrenergic Agents  Alpha and Beta adrenergic agents  Alpha-specific adrenergic agents  Beta specific adrenergic agents Adrenergic agonists (sympathomimetic)  Treat shock  Pupil constriction  Bronchospasm

28 The nurse administer atropine sulfate preoperatively to a client. Preoperative teaching would include which of the following? 1. “This medication will help you relax.” 2. “This medication will decrease the risk of postoperative infection.” 3. “This medication will make you drowsy.” 4. “This medication will make your mouth feel dry.”

29 The nurse administer phenazopyridine (Pyridium) for treatment of a urinary tract infection. Teaching would include advising the client of which effect of the drug? 1. Dry mouth 2. Reddish-orange urine 3. Excessive diuresis 4. Urinary frequency

30 Which statement indicates the client understands the discharge teaching about the appropriate use of lorazepam (Ativan) to manage anxiety? 1. “I can take my medication whenever I feel anxious.” 2. “It is okay to double my dose when I am really anxious.” 3. “It is safe to have one glass of wine with the medication.” 4. “The medication is not for the routine stress of life.”

31 A clients asks why peak and trough levels are being drawn. Which is the best response? 1. “Drawing these blood samples will prevent side effects.” 2. “Drawing these blood samples will allow you to reach the correct drug level quickly.” 3. “Drawing these blood samples allows for adjustment to assure you are receiving correct amount of medication.” 4. “Drawing these blood samples provide your physician with information regarding the type of medication you should be taking.”

32 You administer digoxin (Lanoxin) 0.25 mg to your elderly client for congestive heart failure. Which of the following indicates the desired effect of digoxin? 1. Decreased myocardial contraction 2. Increased urine output 3. Increased heart rate 4. Decreased cardiac output

33 The client is taking warfarin sodium (Coumadin). Which of the following statements would indicate the client understands the discharge teaching? 1. “I should avoid eating green leafy vegetables.” 2. “I should eat at least one serving of broccoli a day.” 3. “I should limit my salt intake”. 4. “I should avoid raw fruits.”

34 A physician order regular insulin 8 units by continuous IV infusion. The IV bag of 100 mL NS has 100 units of regular insulin. The nurse sets the infusion pump at how many mL per hour to deliver 8 units per hour? 1. 1 mL 2. 4 mL 3. 8 mL mL

35 The nurse is monitoring an IV infusion of sodium nitroprusside (Nipride). Fifteen minutes after the infusion is started, the client’s blood pressure goes from 190/120 mm Hg to 120/90 mm Hg. What is the priority nursing action? 1. Recheck the BP and call the physician. 2. Decrease the infusion rate and recheck BP in 5 minutes. 3. Stop the medication and keep the IV open with D5W. 4. Assess the client’s tolerance of the current level of BP.

36 The client will begin taking phenytoin (Dilantin) for a seizure disorder. Which statement indicates that client understands the information about this medication? 1. “I should take my medication before coming to the laboratory to have a blood level drawn.” 2. “I should monitor for side effects and adjust my medication dose depending on how severe the side effects are.” 3. “I should try to avoid alcohol, but if I’m not able to, I can drink alcohol in moderation.” 4. “I need to perform good oral hygiene, including flossing and brushing my teeth.”

37 The client is receiving Ringer’s Lactate. What is the tonicity of the prescribed intravenous solution? 1. Isotonic 2. Normotonic 3. Hypotonic 4. Hypertonic

38 The nurse is teaching the a newly diagnosed diabetic client to obtain glucagon for emergency home use. When the clients asks why, the nurse explains that the purpose is to treat 1. Hypoglycemia from insulin overdose 2. Hyperglycemia from insufficient insulin 3. Lipoatrophy from insulin injections 4. Lipohypertrophy from inadequate insulin absorption.

39 The client received 20 units of NPH insulin subcutaneously at 8 a.m. When should the nurse assess the client for a hypoglycemic reaction? AM AM 3. 5 PM PM

40 The client is admitted to emergency room in diabetic ketoacidosis. The physician orders intravenous insulin. Which type of insulin should the nurse plan to prepare? 1. NPH 2. Regular 3. Lente 4. Ultralente

41 The nurse is administering a dose of isoproterenol hydrochloride (Isuprel) to a client. The nurse monitors for which of the following side effects of this medication? 1. Increased pulse and blood pressure 2. Drowsiness 3. Hyperglycemia 4. Hypokalmia

42 Nursing Science  Intracellular compartment  Extracellular compartment (interstitial fluid) Third-spacing – represents volume loss; unavailable for physiological processes Edema  generalized - anasarca  Intravascular compartment

43 Types of Solutions  Isotonic same osmolality as body fluids increase extracellular fluid  Hypotonic cause movement of water into cells  Hypertonic movement of water from cells  Crystalloids contain electrolytes; used for fluid volume replacement  Colloids plasma expanders move fluids from interstitial to vascular

44 Tonicity of IV Fluids  Isotonic 0.9% saline (NS) 5% dextrose in water (5%DW) 5% dextrose in 0.225% saline (5% D/1/4NS) Lactated ringer’s solution  Hypotonic 0.45% saline (1/2 NS)  Hypertonic 5% dextrose in lactated Ringer’s 5% dextrose in 0.45 saline (5%D1/2NS) 5% dextrose in 0.9% saline (5%D/NS 10% dextrose in water (10%D/W)

45 Types of Blood Components  Red blood cells replace erythrocytes;  H&H in 4-6 hrs  Whole Blood treat hypovolemia  Platelets  Fresh frozen plasma clotting factors no platelets  Albumin 25 gm/100ml = 50 ml plasma  Cryoprecipitates clotting factors

46 Blood Administration  No solution but NS is given with blood product  Medications never added or piggybacked to blood  Infusion should not exceed 4 hours  Check expiration date  Hang within 30 minutes from the lab; never refrigerate on the unit  Check V/S and breath sounds prior to administration, in 15 minutes and every hour thereafter till administration completed.

47 IV Therapy  The smaller the gauge # the larger the diameter of the catheter or needle  Emergency fluid administration or blood needs large bore ( 16, 18, 19 gauge)  Drip chambers Micro 60 drops/ml Macro 10 – 20 drops/ml  Filters

48 IV Therapy  Change IV site q 48 – 72 hrs (agency)  Change tubing q hrs (agency)  Change fluids q 24 hours  No LR with renal failure

49 Sodium ( mEq) Hyponatremia  BP & pulse vary with vascular volume  muscle weakness;  DTR  Headache; personality change  nausea; abdominal cramping   sp gr;  urine output Hypernatremia  BP & pulse related to vascular volume  Pulmonary edema  muscle twitches  muscle weakness;  DTR  * altered mental function

50 Potassium ( ) Hypokalemia  Thready, weak, irregular pulse; orthostatic hypotension; EKG changes  shallow ineffective respirations  confusion, lethargy   motility and bowel sounds Hyperkalemia  slow, weak, irregular pulse; low BP; EKG changes  Muscle weakness  hyperactive bowel sounds

51 Calcium ( ) Hypocalcemia   pulse; hypotension; EKG changes  muscle twitching, cramps, tetany, seizures  parathesias; Positive Trousseau’s & Chvostek’s sign  hyperactive bowel sounds Hypercalcemis   pulse; ; bradycardia then arrest;  BP; EKG changes  muscle weakness  abdominal distention, constipation

52 Magnesium ( ) Hypomagnesemia  EKG changes; tachycardia; hypertension   motility & bowel sounds  tetany; seizures  irritability; confusion Hypermagnesemia  Bradycardia; dysrhythmias; hypotension  muscle weakness  lethargy to coma

53 Phosphate ( ) Hypophosphatemia   contractility  shallow respirations  muscle weakness  rhabdomyolysis  irritability; confusion; & seizures   platelet aggregation; immunosuppression Hyperphosphatemia  as seen in hypocalcemia

54 Practice Question A client is experiencing edema and fluid overload. Which of the following interventions by the nurse will provide the most accurate evaluation of the client’s fluid balance?  1. Measurement of intake and output  2. Assessment of thirst and tissue turgor.  3. Evaluation of changes in daily weight.  4. Evaluation of vital signs every 3 hours.

55 Practice Question Postoperative orders are D 5 1/2 NS with 40 mEq of KCL. The liter of LR solution has not completely infused. What action will the nurse take?  1. Finish the current liter of fluid.  2. Ask the client if he needs to void.  3. Hang the ordered IV.  4. Assess the IV site

56 Practice Question A nurse is preparing to care for a client with a potassium deficit. The nurse recognized that the client is at risk for potassium deficit because the client  1. requires nasogastric suctioning  2. has a history of renal disease.  3. has a history of Addison’s disease.  4. is taking a potassium-sparing diuretic

57 A client is receiving potassium chloride IV, a diuretic, and digoxin. The nurse’s plan of care would be based on which of the following? 1. Hyperkalemia will potentiate the action of digoxin. 2. A potassium-sparing diuretic will not affect the client’s potassium level. 3. Metabolic alkalosis will increase the client’s potassium level. 4. Administration of intravenous potassium chloride should not exceed 10 mEq/hour.

58 The nurse instructs a client with diabetes mellitus about blood glucose monitoring and monitoring for signs of hypoglycemia. The nurse informs the client that hypoglycemia is a blood glucose level of less than mg/dL mg/dL mg/dL mg/dL

59 Normal Blood Gases  pH  Pco  HCO  Po  In acidosis the pH is down  In alkalosis the pH is up  Respiratory function indicator is Pco 2  Metabolic function indicator is bicarbonate

60 Practice Questions The nurse reviews the blood gas results of a clients with Guillain-Barre syndrome. The nurse determines that the client is experiencing respiratory acidosis. Which of the following validates the nurses findings?  1. pH 7.50, Pco 2 52 mm Hg.  2. pH 7.35, Pco 2 40 mm Hg  3. pH 7.25, Pco 2 50 mm Hg  4. pH 7.50, Pco 2 30 mm Hg

61 Practice Question The nurse is reviewing the physician’s orders for a new client. The client has just returned from surgery, is NPO, and has a nasogastric tube. Which order would the nurse question?  1. Potassium 20 mEq IV push  mlD5 ½ 125 ml/hour.  D5W with 40 mEq 100 ml/hour  4. Cefoxitin (Mefoxin) 1 gm RV in 50 ml D5W over 15 minutes.

62 A client is admitted with a blood glucose of 130 mg/dL, bicarbonate is 27 mEq/L, blood pressure is 148/94, and pulse is 88. The first nursing priority will be? 1. Give 40 units of regular insulin. 2. Check urine for sugar and acetone. 3. Encourage deep, slow breaths. 4. Record the admitting baseline data.

63 Which client information, documented during an assessment would be a contraindication to the client receiving verapamil (Calan)? 1. Epigastric pain and treatment for a peptic ulcer. 2. Hypertension and angina on exertion. 3. History of asthma and allergic bronchitis. 4. Hypotension associated with bradycardia.

64 Practice Question The nurse is providing discharge teaching to a client newly diagnosed with rheumatoid arthritis is being discharged on Prednisone. What information is most important to teach the client?  1. Record daily weight to determine weight gain.  2. Increase dose of medication as needed.  3. Do not discontinue medication abruptly.  4. Increase fluid intake

65 Practice Question The client had a colon resection with ileostomy this AM, is receiving an IV of NS at 125 ml per hour, and has a nasogastric tube to suction. Which laboratory value would cause the nurse the most concern?  1. Blood urea nitrogen 32 mg/dl  2. Serum glucose 190 mg/dl.  3. Hemoglobin 13.5, hematocrit 41 %  4. Sodium 155 mEq/L

66 Practice Question A client has returned from the recovery room. He is lethargic but responsive. He has O 4 L via nasal cannula. The initial nursing assessment reveals the O 2 saturation on the pulse oximetry is 82%. What is the priority nursing action?  1. Perform a complete neurological check  2. Increase the O 2 flow and recheck the pulse oximetery.  3. Suction the client and recheck the vital signs.  4. Stimulate the client to cough and deep breathe.

67 Sample Question The nurse is caring for a 15 year-old client with type 1 diabetes. What values on the arterial blood gases would indicate the client is developing a complication as a result of poorly controlled diabetes?  1. Paco 2 48 mm Hg, pH 7.67, Po 2 98 mm Hg., HCO 3 24 mEq/L  2. Paco 2 33 mm Hg, pH 7.48, Po 2 88 mm Hg., HCO 3 26 mEq/L  3. Paco 2 40 mm Hg, pH 7.45, Po 2 82mm Hg., O 2 sat 90%  4. Paco 2 38 mm Hg, pH 7.31, Po 2 82 mm Hg., HCO 3 18

68 A client is experiencing severe diarrhea. The nurse will closely monitor for which acid-base imbalance? 1. Respiratory alkalosis 2. Respiratory acidosis 3. Metabolic acidosis 4. Metabolic alkalosis

69 The client’s arterial blood gases are pH of 7.30, Pco 2 of 58 mm Hg, Po 2 of 80 mm Hg, and a HCO 3 of 27 mEq/L. The client has which acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

70 Nutrition  Basic Human Need Consider clients diagnosis Restrictions Requirements Types of therapeutic diets Nutrients in foods Supplemental feedings Enteral feedings

71 Therapeutic Diets  Clear Liquid  Full liquid  Soft diet Avoid raw fruits & vegetables, fried foods, nuts, & whole grains  Bland diet Avoid alcohol, caffeine, fried foods, peper8 spicy foods  Low-residue High carbohydrate Avoid raw fruits and vegetables, seeds, plant fiber & whole grains; limit dairy

72 Therapeutic diets  High-residue/high fiber diet  Fat controlled diet  High-calorie diet  Sodium -restricted diet  Protein-restricted diet  High-protein diet  Low-calcium diet  High calcium diet

73 Therapeutic diets  Low-purine diet  High-iron diet  Carbohydrate control diet  Vegetarian diet

74 Enteral Nutrition  GI tract functioning

75 Practice Question Which food choices provide the highest calcium intake and are consistent with a low salt dietary program for hypertension?  1. Cheese and macaroni, fresh fruit, milk shake.  2. Cottage cheese, glass of skim milk, orange slices.  3. Roast beef with whole wheat bread, potato, and a vegetable salad.  4. Cheeseburger, French fries, milk shake.

76 Practice Question The nurse is serving a diet tray to a client who has glomerulonephritis and azotemia. Which food selection would the nurse question?  1. Bread and rice.  2. Dried peaches and apricots  3. Bran muffin and eggs.  4. Apples and cucumbers.

77 A client with heart disease is provided instructions regarding a low-fat diet. Which food item should the nurse instruct the client to avoid? 1. Apples 2. Oranges 3. Avocado 4. Cherries

78 The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement if made by the client indicates a need for further teaching? 1. “I need to drink diet soft drinks.” 2. “I’ll eat a balanced meal plan.” 3. “I need to purchase special dietetic foods.” 4. “I’ll snack on fruit instead of cake.”

79 Practice Question The nurse is caring for a client on bed rest. What considerations should be made for the client’s nutritional intake?  1. Intake of breads, rice, and pasta is increased.  2. Bran, whole grains, and fresh green vegetables are increased.  3. Fish and poultry should be increased, with a decrease in beef.  4. Milk and milk products are increased.

80 Parenteral Nutrition  TPN contains glucose, amino acids, water, vitamins, minerals, electrolytes, insulin must be filtered  Fat emulsion no filter  Complications pneumothorax air embolism, fluid overload hyperglycemia infection

81 Practice Question The nurse is preparing to hang a fat emulsion. Fat globules are visible at the top of the solution. The nurse takes which of the following actions?  1. Run the bottle of solution under warm water.  2. Roll the bottle of solution gently.  3. Shake the bottle of solution vigorously.  4. Obtain a different bottle of solution.

82 Sample Question A client receiving TPN is demonstrating manifestations of an air embolism. What is the first action by the nurse?  1. Notify the physician.  2. Place the client in high-Fowlers position.  3. Place the client on the left side in Trendelenburg position.  4. Stop the TPN.

83 Sample Question A nurse is getting a unit of packed blood cells from the blood bank at 1:00. The nurse calculates that the transfusion must be started by  1. 1:30  2. 2:00  3. 2:30  4. 3:00

84 Sample Question A physician orders 1 unit of packed red blood cells to infuse over 4 hours. The unit of blood contains 250 ml. The drop factor is 10 drops per 1 ml. A nurse prepares to set the flow rate at how many drips per minute?  drops  drops  drops  drops

85 The nurse is administering a unit of blood. Select all actions that should be taken to safely administer the blood?  Stay with client during first 15 minutes  Infuse blood within 30 minutes of obtaining from blood bank,  Store blood in unit’s refrigerator until ready to administer.  Use D5½NS to infuse before and after the blood.  Infuse blood as quickly as possible  Verify that informed consent has been obtained

86 The client is receiving a blood transfusion and begins to complain of chills, dyspnea and a headache. The nurse suspects which of the following complications? 1. Transfusion reaction 2. Circulatory overload 3. Septicemia 4. Iron overload


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