The nursing process consists of many steps and they are
Assessment
Diagnosis
Planning
Implementation
Evaluation
Right Drug
Right Time
Right dose
Right patient
Right route
What are the 6 rights of med administration for the patient.
This is information given by the patient or family, include the concerns or symptoms felt by the patient.
Subjective data
Objective data
This involves looking and listening carefully, it is a process that helps you get information about the patient, the patient's problem, and anything that may influence the choice of drug to be given to the patient.
Database
This is measurable data and are obtained when the health care provider gives the patient a physical examination.
Subjective
Objective
The most important time to obtain assessment data on the patient is:
any time care is administered by the nurse
when the patient is first admitted to the hospital
when the patient's condition changes significantly
any time additional objective data is required
The nurse is considering various factors in planning to give a medication. The highest priority step in the planning process is:
collect and use information about the patient and the medication
develop a teaching plan for the patient
decide on a reason for the administration
plan for special equipment that will be needed
The LPN is collecting data for the initial assessment of a patient upon admission to the hospital. Which action should the LPN consider to be the highest priority?
Decide on special equipment that will be needed to administer the patient’s medication.
Monitor the patient for his response to administered medication.
Collect and document a complete set of baseline vital signs.
Review the nursing care plan to verify that it is being followed accurately.
Which patient is most at risk to experience a medication error?
A 38-year old male patient admitted for repair of a fractured femur
A 14 year old female patient who is experiencing a UTI
A 52 year old female presurgical patient who speaks English as a second language
An 82 year old make who is experiencing a cardiac dysrhythmia
What are some ways to identify your patient:
Name
Birth date
Wrist band
Room number
Name on outside of door
Name on the MAR
Name on Medications
Evaluation requires the nurse to watch for the patient's response to a drug, noting both and findings.
These type of drugs have a potential for high abuse, an example of some of these drugs are herion, LSD, marijuana, peyote, and methamphetamine.
Scheduled 1 narcotic
Scheduled 2 narcotic
Scheduled 3 narcotic
Scheduled 4 narcotic
These types of drugs have a high potential for abuse may lead to severe psychologic or physical dependence, some examples of these type of drugs are amphetamines, methadone, morphine, pentobarbital, oxycodone (Percocet).
Scheduled 1 narcotics
Scheduled 2 narcotics
Scheduled 3 narcotics
Scheduled 4 narcotics
Which statements describe the nurse's responsibilities when working with controlled substances?
Medication not administered during a patient's stay can be used for another patient.
The ability to administer controlled substances is determined by state nurse practice acts.
Controlled substances should be monitored for potential health care provider abuse
Nurses can only possess a controlled substance if they are administering them, are in control of a supply, or if the drugs have been prescribed for personal use.
Nurses should immediately discard any refused scheduled controlled medication in the trash.
Whether the prescription is for hospitalized or non-hospitalized patients, the order contains the same information:
Patients full name
Date
Name of drug
Route
Dose
Frequency
Duration
Signature of Prescribers
A physician has prescribed a "now" dose of Lasix 50 mg IV push, this dose should be administered?
Immediately
Within 1.5 hours
With regular scheduled meds
When you finally notice the order has been put in
This is the tendency of the molecules of a substance to move from a region of high concentration to one of lower concentration.
Diffusion
Osmosis
Filtration
This is the diffusion of fluid through a semipermeable membrane; the flow is primarily from the thicker or more concentrated solution or less concentrated solution.
This is the passage of a substance through a filter or through a material that prevents passage of certain molecules.
Per Mrs. Stockdale what is one of the major symptoms of someone who abuses narcotics?
Constipation
Headache
Diarrhea
Memory loss
This is another route for enteral medications, for patients who cannot swallow or who are weal or nauseated may be able to take medications through this tube. It leads directly through the nose and into the stomach.
Nasogastric
Epigastric
Orogastric
Trachostomy
How far in front of the patients mouth should they hold the inhaler or nebulizer for effective administration.
1 to 2 inches
2 to 4 inches
Inside the lips
1.5 to 3 inches
What are you going to do before you squeeze the canister for the patient to inhale the medication.
Have the patient exhale
Have the patient hold their breath
Have the patient Tilt their head back
Have the patient put their chin to their chest
The patient has an order to receive packed red blood cells. The most appropriate needle gauge for the nurse to choose is:
25
23
21
19
The nurse has just administered an intradermal injection. The nurse should inspect the injection site afterward for evidence of a
blister
bleb
bruise
blood droplet
The nurse is administering an IM injection. The most appropriate angle for administration is:
90 degrees
45 degrees
30 degrees
15 degrees
The nurse believes that the client is experiencing an allergic response to the IV fluid that is infusing. The highest priority initial action by the nurse should be:
clamp the tubing
stop the infusion
monitor the patient closely
notify the physician
These are used for the relief of overactive or nonproductive coughs.
Antitussives
Decongestant
Expectorant
Antihistamines
A popular Xanthine Bronchoilator that is effective in management of bronchial constriction and spasm, that is used to relax the smooth muscle cells in the bronchi and blood vessels in the lungs.
theophylline (Elixophyllin)
albuterol (Proventil)
fluticasone (Flovent)
ipratropium bromide (Atrovent)
These directly affect the alpha receptors of blood vessels in the nasal mucosa, causing vasoconstriction and are used to relieve nasal congestion that accompanies allergic rhinitis, sinusitis, and upper respiratory tract infections.
Decongestants
When your taking a decongestant because it is over the counter it is safe to use for as long as you experience symptoms.
These are agents that decrease the thickness of respiratory secretions and aid in their removal; So Guaifenesin is used to treat symptoms of productive cough, these type of products may be useful in chronic respiratory disease when thick mucus is a complication and are indicated in patients with cough.
Antitussive
Antihistamine
While administering a expectorant your nursing actions should be to educate your patient on things that need to be done while taking this medication. You should teach them that
They should drink a full 8 oz glass of water while taking this medication
They should use a air humidifier while using this medication
They should double the dose if the original dose isn't working
They should continue to take this dose for as long as symptoms persist
A patient tells the nurse that he frequently treats his child's chronic allergies with OTC antihistamines. The most appropriate response from the nurse should be:
"Antihistamines are excellent drugs to use to treat children."
"Antihistamines can be used with children if the child is monitored closely."
"Antihistamines are usually not effective when given to children."
"Antihistamines overdosage can be fatal, especially in children."
Your doctor has placed you on Flonase for your nasal congestion, is it safe for him to also administer your immunizations while on this prescription.
What is the drug of choice in the prophylactic treatment of TB infections.
Isoniazid (INH)
Ciprofloxacin
norfloxacin (Noroxin)
levofloxacin (Levaquin)
When a drug is described as an agonist, it means it:
can only work by absorption
will be effective against bacteria
produces an action similar to the body's own chemical
stops other chemicals from working in the body
Drugs that act on a receptor in the body to stop a reaction are referred to as
agonists
partial agonists
antagonists
antireceptors
You've administered a medication to your patient for the first time, with a rapid response they start experiencing tightness in their throat, bronchospasm, feelings of apprehension, tingling and swelling in the face or throat, decrease in BP and elevation of heart rate, or in severe cases loss of consciousness or death.
An allergic reaction
An anaphylactic reaction
An idiosyncratic response
A normal side effect
A patient comes into the clinic complaining of a nonproductive cough and muscle aches for 5 days. She has no sore throat, fever, or swollen lymph nodes. She is coughing so much that she is unable to sleep at night. The physician might order which of the following.
A decongestant
An expectorant
An antitussive
An antibiotic
A patient is experiencing severe headache and pressure over her eyes. She feels congested. She has no temperature elevation. She has a past history of sinus infection. The physician might order which of the following?
You are visiting an 80 year old patient in her home. She is recieving 0.125 mg of oral digoxin (Lanoxin) daily. She also takes hydrochlorothiazide 50 mg bid. She complains of blurred vision and nausea. You observe that she is confused and disoriented at times. Which of the following might be the problem?
The patient needs to have her hydrochlorothiazide increased.
The patient may have digitalis toxicity
The patient may have developed chronic heart failure
The patient may have Alzheimer disease
What are some most common adverse reactions to Antiinfectives?
hypersensitivity
organ toxicity
superinfection
C Diff
hemolysis
QT interval prolongation
When your 80 year old patient is in need of medication that could possible cause a toxicity because it stores in their fat cells and builds and builds instead of working, what is a phrase that you can remember to remind you that elderly patients should take less medicine.
The patient is prescribed transmucosal nitroglycerin tablets. These tablets should be:
chewed
swallowed
placed on the tongue
placed inside the cheek
The nurse is caring for a patient who presents to the ED with symptoms of lightheadness and palpitations. The patient is treated for supraventricular tachycardia. Once stabilized, she is discharged home with a prescription for an oral calcium channel blocker, Which medication does the nurse anticipate that the doctor will prescribe?
Propranolol (Inderal)
Verapamil (Calan)
Adenosine (Adenocard)
Disopyramide (Norpace)
A patient has been prescribed Pyridium as part of treatment for a UTI. Which manifestation warrants the nurse's immediate intervention?
Reddish-orange urine
Vertigo
N & V
Yellow Sclera
Which patient statement indicates an accurate understanding of the correct way to store nitroglycerin?
"I can keep my medication in a cardboard shoe box."
"I can keep my nitroglycerin together with my other pills in my daily container."
"I should keep my medication in the original container including the cotton."
"I should store my nitroglycerin in the refrigerator."
A nurse is caring for a patient with a history of CAD who reports CP 6/10. After obtaining the pt's V/S and administering nitroglycerin, the nurse carefully monitors the patient for which adverse reaction?
Tachypnea
Bradycardia
Hypotension
Hypothermia
The nurse is caring for a patient who is receiving nitroglycerin. Which symptom would prompt the nurse to intervene immediately?
Blurred vision
Flushed face
Dizziness
The LPN has been assigned to care for a patient who is receiving a cardiotonic drug. Before administering the medication, what priority action should the nurse take?
Verify the patients BUN and creatinine levels
Obtain the patients temperature
Auscultate the apical pulse rate for 60 seconds
Auscultate the lungs for wheezing
Which symptoms are indicative of digitalis toxicity?
Tachycardia
Mania
Nausea
Anorexia
The patient has been prescribed niacon. The nurse anticipates tthat the patient will have the most difficulty adjusting to the side effect of:
hyperuricemia
glucose tolerance
flushing
constipation
Your going to administer Digoxin 0.125 mg to your patient for Atrial flutter; once obtaining their apical pulse what is a accurate pulse rate to give this medication under?
< 60 or >100
> 60 or <100
> 50 or < 90
anywhere it doesn't matter about heart rate
What is a appropriate Digoxin level
0.5-2
1-1.5
10-20
12-20
Lidocaine (Xylocaine) may be used for treating which of the following dysrhythmias?
A fib
A flutter
Life-threatening ventricular dysrhythmias
Premature Atrial Contractions
Which of the following is a nitrate compound that is used therapeutically to abort acute attacks of angina pectoris?
Quinidine sulfate
Nirtoglycerin
Digoxin
Minoxidil
A patient is scheduled to leave he hospital tomorrow. He has been instructed to take nitroglycerin sublingually if angina is experienced. Which of the following instructions concerning dosage would he be given?
During an acute attack of angina, he may repeat the dose after 5 to 10 minutes if the pain is not relieved.
He should never repeat a dose but should notify the physician if the pain is not relieved.
If pain is not relieved within 3 to 5 minutes after taking a dose, he should repeat it. He may do this for three doses. If the pain is not relieved, he should chew an aspirin and go immediately to an emergency room.
He can take as many tablets as necessary until relief occurs.
The negative chronotropic side effect in patients receiving Digoxin is evidenced by:
increased heart rate
decreased heart rate
decreased contraction
increased ectopic beats
These products are vasodilators and so have a direct action on vascular smooth muscle and cause it to relax, they increase the use of the other small blood vessels in the heart so that there is better oxygen supply to the inner layers of the heart muscle.
Nitrates
Calcium channel blocker
Peripheral Vasodilators
Angioedema
Your patient has come to the office experiencing chest pain and elevated heart rate of 120 Sinus tachycardia, you would expect the doctor to write them a prescription for what type of dysrhythmia treatment.
propranolol
digoxin
lidocaine
verapamil
Your patient has been seen in the office for a dysrhythmia, heart rate 160 irregular Afib, what would you expect the doctor to write this particularity patient a prescription for:
They prescribed your patient propranolol daily for high blood pressure, you know that this know as what type of drug
Beta blocker
Ace inhibitor
Statin
Loop diuretics
They prescribed your patient lisinopril daily for blood pressure, you know that this know as what type of drug
ACE inhibitor
Statins
Loop Diuretics
A severe side effect of ACE inhibitors is
Flushing
Alopecia
Your patient has presented with hyperlipidemia, they doctor has prescribed a HMG-CoA you understand this is what type of drug:
ACE Inhibitor
The action of all diuretics is to increase fluid loss from the body. This type of drug acts directly to dilate the smooth muscles in the arterioles and works to prevent the reabsorption of sodium and chloride, may lead to the loss of large amounts of potassium and also works to promote reabsorption of calcium.
Thiazides
Potassium-sparing diuretics
Thiazide-like sulfonamides
The action of all diuretics is to increase fluid loss from the body. This acts by blocking active transport of chloride, sodium, and potassium in the thick ascending loop of Henle. These are often used in patients with kidney disease and to treat CHF, cirrhosis of the liver.
Thiazide
The action of all diuretics is to increase fluid loss from the body. This type increases the excretion of water and sodium but saves K+, These drugs are used in patients with kidney disease, in older adult patients with poor kidney function who have hypokalemia, or in those patients with the risk for having hypokalemia.
Loop diuretic
Potassium-sparing diuretic
When giving elderly patients antihypertensive medications this must be done with precaution because they are most at risk for what type of side effect?
hypertensive crisis
postural hypotension
angioedema
hypokalemia
Nerves send or transmit information from the brain through chemical messengers known as:
basal ganglia
peripheral nervous system
neurotransmitters
central nervous system
Patients taking phenytoin (Dilatin), should be instructed to:
comply with serum liver function lab appointments
include foods high in vitamin D and folic acid in their diets
monitor for signs of infection
take the drug in the morning to mimic natural body systems responses
Antivertigo-antiemtic drugs act by:
causing an increase threshold in the vomiting center
producing a therapeutic serum level that is monitored monthly
producing drowsiness and thus inhibiting nausea
reducing the levels of dopamine and acetylcholine
These type of agents block nerve impulses in the receptors of the sympathetic nervous system and so may be used for either prevention or treatment and should be given as soon as the pain begins.
Antimigraine
Anticholinergic
Antiepileptic
Anticonvulsants
Your diabetic patient is having symptoms: sudden onset of nervousness, visual disturbances, hunger, malaise, cold, clammy skin, lethargy, pallor, diaphoresis, change in level of consciousness, confusion, abnormal behavior, shallow respiration's, feeling of heart pounding or racing, shakiness, sudden anxiety or tingling sensation around the mouth.
hypoglycemia
hyperglycemia
Your diabetic patient is having symptoms: Increased thirst, dry mouth, frequent urination, fatigue, headache, blurred vision.
The nurse is caring for a patient who is receiving treatment with an MAO inhibitor (MAOI) medication. Which patient statement indicates that the patient correctly understands dietary restrictions associated with MAOIs?
"I should refrain from eating any ice cream."
I should refrain from drinking orange juice."
"I should refrain from eating chicken."
"I should refrain from eating avocados."
The LPN is caring for a patient who is being treated with an ergot alkaloid medication. Which statement about ergot alkaloids as prophylactic treatment of vascular headaches is correct?
Ergot alkaloids are cholinergic drugs
Ergot alkaloids are adrenergic-blocking agents.
Ergot alkaloids are anticholinergic agents.
Ergot alkaloids are sympathomimetic drugs.
A patient calls the office and states that he has been taking sertraline (Zoloft) for almost a week without any symptom relief. How should the nurse advise the patient?
"The drug should have an immediate effect on your symptoms."
"It may take a few weeks before you experience significant effects of the medication."
"You need to increase your dose of the sertraline."
"Your health care provider needs to add additional medications."
This drug is used intravenously to control seizures and is the drug of choice for treatment of status epilepticus.
Diazepam (Valium)
Phenobarbital (Luminal)
pheytoin (Dilantin)
gabapentin ((Neurontin)
Your checking your patients labs and you notice that their Lithium level is within range at:
3.5-5
0.8-2
What is the go to drug for antiparkinsinians?
carbidopa-levodopa (Sinemet)
diphenhydramine (Benadryl)
diazepam (Valium)
lorazepam (Ativan)
MAOI may cause very dangerous reactions if taken with certain foods or beverages containing what ingredient?
tyramine
milk
peanuts
shellfish
Which signs and symptoms are associated with narcotic use?
Confusion
Psychologic dependence
Decreased urine output
Respiratory stimulation
The LPN is caring for a patient who is scheduled to receive his first dose of a pain medication. Which information is most important for the nurse to obtain?
Ask the patient to rate his pain using a 1-to-10 scale.
Ask the patient about his history of allergies.
Ask the patient to describe his coping methods.
Ask the patient to describe unusual symptoms with this medication.
Which analgesics are classified as Schedule II drugs?
Codeine
Fentanyl
Meperidine
Pentazocine
Methadone
Propoxyphene
Which patient on opioid therapy is most susceptible to the side effect of constipation?
A 25-year-old female receiving chemotherapy for ovarian cancer
A 42-year-old male with depression
A 55-year-old female with sickle cell crisis
A 74-year-old male with a femur fracture
The LPN suspects that a patient may have overdosed on narcotics. Which medication does the nurse anticipate that the physician will order?
Naloxone
Nalbuphine
Butorphanol
The LPN is caring for a patient who is being treated with intramuscular injections of pentazocine. Which action is most important for the nurse to take?
Rotate injection sites with every dose of medication.
Give the medication subcutaneously every three doses.
Ask the physician if the patient can take the medication orally.
Monitor the patient for development of blood clots.
A 2-year-old child has returned from surgical repair of a wrist fracture and is crying from pain. In addition to administering the prescribed analgesic, which nonpharmacologic treatment should the nurse implement?
Guided imagery
Heat
Distraction
TENS
Name three drugs classified as opioid agonist analgesics
Hydrocodone
Oxycodone
Narcan
This type of pain is usually related to an injury, such as recent surgery, trauma, or infection, and ends within an expected time.
Acute
Chronic
This type of pain is any pain that continues beyond the usual course of an acute injury process.
This opioid mechanism of action is it binds with the receptors to activate and produce the maximum response of the individual receptor.
Agonist
Partial agonist
Agonist antagonist
This opioid mechanism of action that produces a partial response.
The opioid mechanism of action that acts as an agonist at one type of receptor and as a competitive antagonist at another type of receptor.
Opioid overdosage may produce sedation and respiratory depression.
What is the first line of defense drug with osteoarthritis?
Acetaminophen
NSAIDS
ibuprofen
Tordal
This type of antiinflammatory and analgesic agent causes peptic ulcers or GI bleeding if over used.
Aspirin
Ibuprofen
This is going to be the select all that apply question on the final so remember verbatim!!!
List four adverse reactions to thrombolytic agents?
Bleeding
dysrhythmias
polyneuropathy
hypotension
cholesterol embolism
pulmonary embolism
A patient is admitted to the hospital inpatient treatment unit for alcohol intoxication. After 2 days without alcohol, he is medically stable enough to begin therapy. He begins individual therapy and group sessions with AA. Prior to discharge, the physician might also start him on which of the following.
Simethicone
Disulfiram
Psyllium seed
Magnesium hydroxide
A laxative that works to soften the stool is an
lubricant laxative
stimulant laxative
bulk forming laxative
emollient laxative
AquaMEPHYTON, vitamin K1, is an example of a/an:
anticoagulant
hematinic
thrombolytic
hemostatic
Vitamin K is the antidote for heparin overdose
Coumarin or indandione derivatives are indicatedfor long term therapy.
The coumarin and indandione derivatives destroy existing blood clots
All anticoagulants prevent formation of blood clots block the ability of platelets to stick( formation of blood clots, block the ability of platelets to stick ), or thrombi, by interfering with this complex clotting mechanisms of blood and increasing the time it takes for blood to clot.
Vitamin K must be present to produce and other clotting factors that are made in the:
liver
small intestine
large intestine
gallbladder
is the drug of choice in treating ischemic stroke.
The prothrombin time (PT) of a patient who is on long term Coumadin prophylaxis should be:
within the range of the activated partial thromboplastin time (PTT)
unchanged
1.5 to 2 times the normal valve
3 o 4 times the normal valve
An OTC medication used for a suspected thrombolytic event is
Coumadin
aspirin
streptokinase
Tylenol
A patient receiving long-term anticoagulant therapy (Coumadin) should:
receive daily assessment of INR levels
consume foods high in vitamin C
limit foods high in vitamin K
use aspirin for pain relief
List examples of when anticoagulant therapy is used:
to prevent new clot formation
stop existing clots from growing
prophylactically during & after surgery
patient with heart valve disease
hemodialysis
head injury
List some drugs that increase the risk of bleeding and hemorrhage in a patient receiving heparin.
Coumarin
methimazole
propylthiouracil
ASA
digitalis
nicotine
tetracycline
The nurse should carefully monitor the vital signs of a patient receiving thrombolytic therapy and carefully observe for bleeding loss of consciousness confusion need for urination( bleeding, loss of consciousness, confusion, need for urination ).
List two uses for thrombolytic agents.
to dissolve clots from pulmonary emboli or a coronary artery thrombosis
clear IV catheters obstructed by clotted blood or fibrin
to form clot to keep patient from bleeding
an agent you place in the IV to keep the blood from back up into it
What is the typical INR goal for a patient
2-3
How do they determine the dose for heparin therapy?
WT
HT
BMI
AGE
You can give heparin two ways:
IV
SUBQ
IM
TABLET
What is the lab for Heparin check
aPTT
PT/INR
PT
INR
What is the Lab check for warfarin/coumadin?
PCTA
DVT
This type of insulin normal ends in Log is always clear has an onset of 5-15 mins. Examples: Lispro (Humalog), aspart (Novolog)
Rapid-acting
Short-acting
Intermediate-acting
Long-acting
This type of insulin normal begins with an R is clear is the only one that can be given IV has an onset of 30-60 mins.
This type of insulin always begins with an N, never used on a sliding scale, cloudy in color has an onset of 2-4 hours
This type of insulin always begins with an L is never used on sliding scale is clear in color, used in high doses, never mixed with anything requires NO CBG or accucheck with this one and has no peak time.
This is a proton pump inhibitor that decreases the amount of acid produced in the stomach
Protonix
Levothyroxine
A patient is found to have hyperthyroidism. The doctor wants to start her on medication therapy before performing surgery. He is most likely to prescribe which of the following?
Levothyroxine (Levothrid, Synthroid, others)
Liotrix (Thyrolar)
Liothyronine (Cytomel, Triostat)
Propylthiouracil (PTU)
Hyperthyroidism Hypothyroidism( Hyperthyroidism, Hypothyroidism ) is where your fingers are clubbed, you have tremors, elevated diarrhea, intolerance to heat, fine straight hair, bulging eyes, facial flushing, enlarged thyroid, tachycardia, elevated BP, breast enlargement, WT loss, muscle wasting and localized edema.
Hypothyroidism Hyperthyroidism( Hypothyroidism, Hyperthyroidism ) is where you have hair loss, apathy, lethargy, dry skin, muscle aches, constipation, intolerance to cold, receding hairline, facial and eyelid edemas, dull-blank expression, extreme fatigue, thick tongue, slow speech, anorexia, brittle nails and hair, and menstrual disturbances.
Your checking your patient's PT/INR what is the normal ranges that your looking for?
1.5-3.5
Your patient's specific gravity should be within 1.010-1.030
