Transcript NCLEX-RN: PHARMACOLOGY & NURSING SCIENCES Created by Dare Domico, RN, DSN

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 diseasespecific 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
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
The nurse administer atropine sulfate preoperatively to a
client. Preoperative teaching would include which of the
following?
1.
2.
3.
4.
“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.”
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.
2.
3.
4.
Dry mouth
Reddish-orange urine
Excessive diuresis
Urinary frequency
Which statement indicates the client understands the
discharge teaching about the appropriate use of
lorazepam (Ativan) to manage anxiety?
1.
2.
3.
4.
“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. Which is the best response?
1.
2.
3.
4.
“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.”
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.
2.
3.
4.
Decreased myocardial contraction
Increased urine output
Increased heart rate
Decreased cardiac output
The client is taking warfarin sodium (Coumadin).
Which of the following statements would indicate the
client understands the discharge teaching?
1.
2.
3.
4.
“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. 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.
2.
3.
4.
1 mL
4 mL
8 mL
10 mL
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.
2.
3.
4.
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?
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.”
The client is receiving Ringer’s Lactate. What is
the tonicity of the prescribed intravenous
solution?
1. Isotonic
2. Normotonic
3. Hypotonic
4. Hypertonic
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.
2.
3.
4.
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. When should the nurse assess
the client for a hypoglycemic reaction?
1.
2.
3.
4.
10 AM
11 AM
5 PM
11 PM
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.
2.
3.
4.
NPH
Regular
Lente
Ultralente
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.
2.
3.
4.
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


movement of water from cells
Crystalloids


cause movement of water into cells
Hypertonic


same osmolality as body fluids
increase extracellular fluid
contain electrolytes; used for fluid volume replacement
Colloids


plasma expanders
move fluids from interstitial to vascular
Tonicity of IV Fluids

Isotonic





Hypotonic


0.9% saline (NS)
5% dextrose in water (5%DW)
5% dextrose in 0.225% saline (5% D/1/4NS)
Lactated ringer’s solution
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


Whole Blood



clotting factors no platelets
Albumin


treat hypovolemia
Platelets
Fresh frozen plasma


replace erythrocytes;  H&H in 4-6 hrs
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)
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)
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)
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. The nurse’s plan of care would be based on
which of the following?
1.
2.
3.
4.
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.
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
1.
2.
3.
4.
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.
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.
2.
3.
4.
Give 40 units of regular insulin.
Check urine for sugar and acetone.
Encourage deep, slow breaths.
Record the admitting baseline data.
Which client information, documented during an
assessment would be a contraindication to the client
receiving verapamil (Calan)?
1.
2.
3.
4.
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
A client is experiencing severe diarrhea. The nurse will
closely monitor for which acid-base imbalance?
1.
2.
3.
4.
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
Metabolic 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?
1.
2.
3.
4.
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
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.
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.
2.
3.
4.
Apples
Oranges
Avocado
Cherries
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.
2.
3.
4.
“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


Fat emulsion


must be filtered
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
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?
1.
2.
3.
4.
Transfusion reaction
Circulatory overload
Septicemia
Iron overload