Presentation on theme: "NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES"— Presentation transcript:
1NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES Created by Dare Domico, RN, DSNRevised by Brenda Rowe
2Answering Pharmacology Questions If familiar with the medication, use nursing knowledge to answerWill identify the generic and the trade nameForm a relationship between medication and medical diagnosisDetermine the classification of the medication; will assist with action and side effects
3Answering Pharmacology Questions Recognize side effects associated with classification and relate nursing interventionsLearn 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
5Answering Pharmacology Questions Points to RememberDo not take antacid with medicationsDo not crush enteric-coated & sustained release tabletsCapsules should not be openedThe nurse never adjust or change a medication dose or abruptly stop medicationAvoid alcohol and smokingQuestion (and hold) medications if the order is unclear, or dose is not a normal one.
6Answering Pharmacology Questions Trough level is lowest level of drug plasma concentration; draw prior to dose. Used with drugs that are toxic.
7Nursing PriorityThe 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.
8Practice QuestionOrally 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 medication1. Just after breakfast2. With a snack at 3 PM3. In the morning on an empty stomach4. With food
9Practice QuestionA 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 apply1. Constipation2. Dizziness3. Headache4. Hyperglycemia5. Hypotension6. Impotence
10Sample questionAn 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?
111st weight from lb to kg145 lb = 65.8 kgMultiply weight in kg by number of micrograms desired per kg1645 mcg
12Sample questionThe nurse is verifying whether to give a medication to a client. What should the nurse check first?1. Client’s name2. Expiration date of the drug.3. Route of delivery.4. Chart to see whether the drug was ordered.
13Sample questionThe 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?
14Sample question1. 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.
15Generic NameBrand NameTherapeutic drug class (Classification)Action on body (therapeutic actions)IndicationsContraindicationsDosageAdverse effectsDrug-food interactionNursing ConsiderationsAssessmentImplementationTeaching points
17Anti-infective Toxic to infective agent No effect on human host cells Immune system activity neededAdverse effectsToxic effects on kidney, GI tract, & nervous system.Hypersensitivity and super infections
18Antibiotics 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.
19Aminoglycosides Mycin drugs Renal and hepatic toxicity Avoid with herpes and parkinsonismAvoid with strong diuretics
24Drugs Acting on CNS Anxiolytic and Hypnotic Agents Antidepressant AgentsPsychotropic AgentsAntiepileptic AgentsAntiparkinsonism AgentsMuscle RelaxantsNarcotics & Antimigraine AgentsGeneral & local Anesthetic AgentsNeuromuscular Junction Blocking Agents
25Antiparkinsonism Agents AnticholinergicsOppose the effects of acetylcholine at receptor sites to normalize the acetylcholine-dopamine imbalance,DopaminergicsIncrease the effects of dopamine at receptor sites.
27Adrenergic Agents Alpha and Beta adrenergic agents Alpha-specific adrenergic agentsBeta specific adrenergic agentsAdrenergic agonists (sympathomimetic)Treat shockPupil constrictionBronchospasm
28“This medication will help you relax.” The nurse administer atropine sulfate preoperatively to a client. Preoperative teaching would include which of the following?“This medication will help you relax.”“This medication will decrease the risk of postoperative infection.”“This medication will make you drowsy.”“This medication will make your mouth feel dry.”
29Dry mouth Reddish-orange urine Excessive diuresis Urinary frequency The nurse administer phenazopyridine (Pyridium) for treatment of a urinary tract infection. Teaching would include advising the client of which effect of the drug?Dry mouthReddish-orange urineExcessive diuresisUrinary frequency
30“I can take my medication whenever I feel anxious.” Which statement indicates the client understands the discharge teaching about the appropriate use of lorazepam (Ativan) to manage anxiety?“I can take my medication whenever I feel anxious.”“It is okay to double my dose when I am really anxious.”“It is safe to have one glass of wine with the medication.”“The medication is not for the routine stress of life.”
31A clients asks why peak and trough levels are being drawn A clients asks why peak and trough levels are being drawn. Which is the best response?“Drawing these blood samples will prevent side effects.”“Drawing these blood samples will allow you to reach the correct drug level quickly.”“Drawing these blood samples allows for adjustment to assure you are receiving correct amount of medication.”“Drawing these blood samples provide your physician with information regarding the type of medication you should be taking.”
32Decreased myocardial contraction Increased urine output 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?Decreased myocardial contractionIncreased urine outputIncreased heart rateDecreased cardiac output
33The client is taking warfarin sodium (Coumadin) The client is taking warfarin sodium (Coumadin). Which of the following statements would indicate the client understands the discharge teaching?“I should avoid eating green leafy vegetables.”“I should eat at least one serving of broccoli a day.”“I should limit my salt intake”.“I should avoid raw fruits.”
34A physician order regular insulin 8 units by continuous IV infusion 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 mL4 mL8 mL10 mL
35Recheck the BP and call the physician. 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?Recheck the BP and call the physician.Decrease the infusion rate and recheck BP in 5 minutes.Stop the medication and keep the IV open with D5W.Assess the client’s tolerance of the current level of BP.
36The client will begin taking phenytoin (Dilantin) for a seizure disorder. Which statement indicates that client understands the information about this medication?“I should take my medication before coming to the laboratory to have a blood level drawn.”“I should monitor for side effects and adjust my medication dose depending on how severe the side effects are.”“I should try to avoid alcohol, but if I’m not able to, I can drink alcohol in moderation.”“I need to perform good oral hygiene, including flossing and brushing my teeth.”
37The client is receiving Ringer’s Lactate The client is receiving Ringer’s Lactate. What is the tonicity of the prescribed intravenous solution?IsotonicNormotonicHypotonicHypertonic
38Hypoglycemia from insulin overdose 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 treatHypoglycemia from insulin overdoseHyperglycemia from insufficient insulinLipoatrophy from insulin injectionsLipohypertrophy from inadequate insulin absorption.
39The client received 20 units of NPH insulin subcutaneously at 8 a. m The client received 20 units of NPH insulin subcutaneously at 8 a.m. When should the nurse assess the client for a hypoglycemic reaction?10 AM11 AM5 PM11 PM
40NPH Regular Lente Ultralente 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?NPHRegularLenteUltralente
41Increased pulse and blood pressure Drowsiness Hyperglycemia Hypokalmia 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?Increased pulse and blood pressureDrowsinessHyperglycemiaHypokalmia
43Types of Solutions Isotonic Hypotonic Hypertonic Crystalloids Colloids same osmolality as body fluidsincrease extracellular fluidHypotoniccause movement of water into cellsHypertonicmovement of water from cellsCrystalloidscontain electrolytes; used for fluid volume replacementColloidsplasma expandersmove fluids from interstitial to vascular
44Tonicity of IV Fluids Isotonic Hypotonic Hypertonic 0.9% saline (NS) 5% dextrose in water (5%DW)5% dextrose in 0.225% saline (5% D/1/4NS)Lactated ringer’s solutionHypotonic0.45% saline (1/2 NS)Hypertonic5% dextrose in lactated Ringer’s5% dextrose in 0.45 saline (5%D1/2NS)5% dextrose in 0.9% saline (5%D/NS10% dextrose in water (10%D/W)
45Types of Blood Components Red blood cellsreplace erythrocytes; H&H in 4-6 hrsWhole Bloodtreat hypovolemiaPlateletsFresh frozen plasmaclotting factors no plateletsAlbumin25 gm/100ml = 50 ml plasmaCryoprecipitatesclotting factors
46Blood Administration No solution but NS is given with blood product Medications never added or piggybacked to bloodInfusion should not exceed 4 hoursCheck expiration dateHang within 30 minutes from the lab; never refrigerate on the unitCheck V/S and breath sounds prior to administration, in 15 minutes and every hour thereafter till administration completed.
47IV TherapyThe smaller the gauge # the larger the diameter of the catheter or needleEmergency fluid administration or blood needs large bore ( 16, 18, 19 gauge)Drip chambersMicro 60 drops/mlMacro 10 – 20 drops/mlFilters
48IV Therapy Change IV site q 48 – 72 hrs (agency) Change tubing q hrs (agency)Change fluids q 24 hoursNo LR with renal failure
49Sodium (135 - 145mEq) Hypernatremia HyponatremiaBP & pulse vary with vascular volumemuscle weakness; DTRHeadache; personality changenausea; abdominal cramping sp gr; urine outputHypernatremiaBP & pulse related to vascular volumePulmonary edemamuscle twitchesmuscle weakness; DTR* altered mental function
52Magnesium (1.6 - 2.6) Hypomagnesemia EKG changes; tachycardia; hypertensionmotility & bowel soundstetany; seizuresirritability; confusionHypermagnesemiaBradycardia; dysrhythmias; hypotensionmuscle weaknesslethargy to coma
53Phosphate (2.7 - 4.5) Hypophosphatemia contractility shallow respirationsmuscle weaknessrhabdomyolysisirritability; confusion; & seizures platelet aggregation; immunosuppressionHyperphosphatemiaas seen in hypocalcemia
54Practice QuestionA 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 output2. Assessment of thirst and tissue turgor.3. Evaluation of changes in daily weight.4. Evaluation of vital signs every 3 hours.
55Practice QuestionPostoperative orders are D51/2 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
56Practice QuestionA 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 client1. requires nasogastric suctioning2. has a history of renal disease.3. has a history of Addison’s disease.4. is taking a potassium-sparing diuretic
57A client is receiving potassium chloride IV, a diuretic, and digoxin 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?Hyperkalemia will potentiate the action of digoxin.A potassium-sparing diuretic will not affect the client’s potassium level.Metabolic alkalosis will increase the client’s potassium level.Administration of intravenous potassium chloride should not exceed 10 mEq/hour.
58120 mg/dL 110 mg/dL 90 mg/dL 60 mg/dL 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 than120 mg/dL110 mg/dL90 mg/dL60 mg/dL
59Normal Blood Gases pH 7.35-7.45 Pco2 35-45 HCO2 22-27 Po2 80-100 In acidosis the pH is downIn alkalosis the pH is upRespiratory function indicator is Pco2Metabolic function indicator is bicarbonate
60Practice QuestionsThe 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, Pco2 52 mm Hg.2. pH 7.35, Pco2 40 mm Hg3. pH 7.25, Pco2 50 mm Hg4. pH 7.50, Pco2 30 mm Hg
61Practice QuestionThe 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 pushmlD5 ½ 125 ml/hour.D5W with 40 mEq 100 ml/hour4. Cefoxitin (Mefoxin) 1 gm RV in 50 ml D5W over 15 minutes.
62Give 40 units of regular insulin. Check urine for sugar and acetone. 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?Give 40 units of regular insulin.Check urine for sugar and acetone.Encourage deep, slow breaths.Record the admitting baseline data.
63Epigastric pain and treatment for a peptic ulcer. Which client information, documented during an assessment would be a contraindication to the client receiving verapamil (Calan)?Epigastric pain and treatment for a peptic ulcer.Hypertension and angina on exertion.History of asthma and allergic bronchitis.Hypotension associated with bradycardia.
64Practice QuestionThe 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
65Practice QuestionThe 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/dl2. Serum glucose 190 mg/dl.3. Hemoglobin 13.5, hematocrit 41 %4. Sodium 155 mEq/L
66Practice QuestionA client has returned from the recovery room. He is lethargic but responsive. He has 4 L via nasal cannula. The initial nursing assessment reveals the O2 saturation on the pulse oximetry is 82%. What is the priority nursing action?1. Perform a complete neurological check2. Increase the O2 flow and recheck the pulse oximetery.3. Suction the client and recheck the vital signs.4. Stimulate the client to cough and deep breathe.
67Sample QuestionThe 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. Paco2 48 mm Hg, pH 7.67, Po2 98 mm Hg., HCO3 24 mEq/L2. Paco2 33 mm Hg, pH 7.48, Po2 88 mm Hg., HCO3 26 mEq/L3. Paco2 40 mm Hg, pH 7.45, Po2 82mm Hg., O2 sat 90%4. Paco2 38 mm Hg, pH 7.31, Po2 82 mm Hg., HCO3 18
68Respiratory alkalosis Respiratory acidosis Metabolic acidosis A client is experiencing severe diarrhea. The nurse will closely monitor for which acid-base imbalance?Respiratory alkalosisRespiratory acidosisMetabolic acidosisMetabolic alkalosis
69Respiratory alkalosis The client’s arterial blood gases are pH of 7.30, Pco2 of 58 mm Hg, Po2 of 80 mm Hg, and a HCO3 of 27 mEq/L. The client has which acid-base imbalance?Metabolic acidosisMetabolic alkalosisRespiratory acidosisRespiratory alkalosis
70Nutrition Basic Human Need Consider clients diagnosis Restrictions RequirementsTypes of therapeutic dietsNutrients in foodsSupplemental feedingsEnteral feedings
71Therapeutic Diets Clear Liquid Full liquid Soft diet Bland diet Avoid raw fruits & vegetables, fried foods, nuts, & whole grainsBland dietAvoid alcohol, caffeine, fried foods, peper8 spicy foodsLow-residueHigh carbohydrateAvoid raw fruits and vegetables, seeds, plant fiber & whole grains; limit dairy
75Practice QuestionWhich 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.
76Practice QuestionThe 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 apricots3. Bran muffin and eggs.4. Apples and cucumbers.
77Apples Oranges Avocado Cherries A client with heart disease is provided instructions regarding a low-fat diet. Which food item should the nurse instruct the client to avoid?ApplesOrangesAvocadoCherries
78“I need to drink diet soft drinks.” “I’ll eat a balanced meal plan.” 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?“I need to drink diet soft drinks.”“I’ll eat a balanced meal plan.”“I need to purchase special dietetic foods.”“I’ll snack on fruit instead of cake.”
79Practice QuestionThe 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.
81Practice QuestionThe 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.
82Sample QuestionA 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.
83Sample QuestionA 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 by1. 1:302. 2:003. 2:304. 3:00
84Sample QuestionA 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?dropsdropsdropsdrops
85Stay with client during first 15 minutes 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 minutesInfuse 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 possibleVerify that informed consent has been obtained
86The client is receiving a blood transfusion and begins to complain of chills, dyspnea and a headache. The nurse suspects which of the following complications?Transfusion reactionCirculatory overloadSepticemiaIron overload