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

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

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

What are the --- “pril” “lol”

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.

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

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.

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

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

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?

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

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.

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?

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.

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

Chemotherapeutic Agents Anti-infective Antibiotics Antiviral Antifungal Antiprotozoal Anthelmintic Antineoplastic

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

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.

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

Cephalosporin Penicillin like

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

Anti-inflamatory NSAIDS Antigout

Antitoxins.Antiveniom 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

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

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.

GI drugs Antacids Laxative H2 histamine antagonist

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

“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.”

Dry 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 mouth Reddish-orange urine Excessive diuresis Urinary frequency

“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.”

A 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.”

Decreased 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 contraction Increased urine output Increased heart rate Decreased cardiac output

The 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.”

A 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 mL 4 mL 8 mL 10 mL

Recheck 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.

The 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.”

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

Hypoglycemia 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 treat Hypoglycemia from insulin overdose Hyperglycemia from insufficient insulin Lipoatrophy from insulin injections Lipohypertrophy from inadequate insulin absorption.

The 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 AM 11 AM 5 PM 11 PM

NPH 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? NPH Regular Lente Ultralente

Increased 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 pressure Drowsiness Hyperglycemia Hypokalmia

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

Types of Solutions Isotonic Hypotonic Hypertonic Crystalloids Colloids 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

Tonicity 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 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)

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

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.

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

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

Sodium (135 - 145mEq) Hypernatremia 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

Potassium (3.5 - 5.1) Hyperkalemia 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

Calcium (8.6 - 10) Hypercalcemis 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

Magnesium (1.6 - 2.6) Hypomagnesemia EKG changes; tachycardia; hypertension motility & bowel sounds tetany; seizures irritability; confusion Hypermagnesemia Bradycardia; dysrhythmias; hypotension muscle weakness lethargy to coma

Phosphate (2.7 - 4.5) Hypophosphatemia contractility shallow respirations muscle weakness rhabdomyolysis irritability; confusion; & seizures  platelet aggregation; immunosuppression Hyperphosphatemia as seen in hypocalcemia

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.

Practice Question Postoperative 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

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

A 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.

120 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 than 120 mg/dL 110 mg/dL 90 mg/dL 60 mg/dL

Normal Blood Gases pH 7.35-7.45 Pco2 35-45 HCO2 22-27 Po2 80-100 In acidosis the pH is down In alkalosis the pH is up Respiratory function indicator is Pco2 Metabolic function indicator is bicarbonate

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, Pco2 52 mm Hg. 2. pH 7.35, Pco2 40 mm Hg 3. pH 7.25, Pco2 50 mm Hg 4. pH 7.50, Pco2 30 mm Hg

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 2. 1000 mlD5 ½ NS @ 125 ml/hour. 3. 1000 D5W with 40 mEq potassium @ 100 ml/hour 4. Cefoxitin (Mefoxin) 1 gm RV in 50 ml D5W over 15 minutes.

Give 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.

Epigastric 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.

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

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

Practice Question A client has returned from the recovery room. He is lethargic but responsive. He has O2@ 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 check 2. 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.

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. Paco2 48 mm Hg, pH 7.67, Po2 98 mm Hg., HCO3 24 mEq/L 2. Paco2 33 mm Hg, pH 7.48, Po2 88 mm Hg., HCO3 26 mEq/L 3. 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

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

Respiratory 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 acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

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

Therapeutic Diets Clear Liquid Full liquid Soft diet Bland 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

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

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

Enteral Nutrition GI tract functioning

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.

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.

Apples 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? Apples Oranges Avocado Cherries

“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.”

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.

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

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.

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.

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

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? 1. 10 drops 2. 15 drops 3. 17 drops 4. 20 drops

Stay 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 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

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? Transfusion reaction Circulatory overload Septicemia Iron overload