Wednesday, January 23, 2008

Drugs:Endocrine System Questions

1. The nurse is teaching a patient about insulin injections. Which statement is correct?
a. Insulin needs to be shaken well before being drawn up into the syringe
b. Long-acting insulins are clear in color
c. When putting regular and NPH insulin in the same syringe, draw regular insulin up first
d. NPH is compatible with regular and lente insulin


C - Regular insulin should be drawn up before NPH insulin when putting the two together in one syringe.


2. The nurse tells the patient that she can minimize local skin reactions to insulin by:
a. injecting it slowly
b. always refrigerating it
c. giving it in divided doses
d. bringing it to room temperature before administering


D - Insulin should be at room temperature before injecting to decrease occurrence of lipodystrophy.


3. Which statement by the patient indicates a need for further teaching by the nurse?
a. "I will inject my insulin at a 90degrees angle."
b. "I will take more insulin when I go to my exercise class."
c. "I will always have some kind of sugar with me in case I have a hypoglycemic reaction."
d. "I will carefully draw up my doses of insulin."


B - Exercise increases glucose use in the body, so a decreased dose of insulin may be needed.


4. A patient tells the nurse that his brother has Type I diabetes and he takes insulin. The patient asks the nurse why his brother cannot take an oral anti-diabetic agent. The nurse explains that oral anti-diabetic agents are not effective in Type I diabetes because people with this type:
a. have little or no endogenous insulin that can be released
b. are allergic to oral anti-diabetic agents
c. would need so much of an oral anti-diabetic agent that it would be financially prohibitive for them to take one
d. would ahve more episodes of hypoglycemia iwth oral antidiabetic agents


A - Oral antidaibetic agents can only work when the client has endogenous insulin, which is not the case in Type I diabetes.


5. A person should not take tolbutamide (Orinase) if allergic to:
a. penicillin
b. insulin
c. sulfa
d. caffeine


C - Clients who are allergic to sulfa drugs cannot take tolbutamide (Orinase), which is a sulfonylurea.


6. A patient will need more teaching about tolbutamide (Orinase) if he makes the following statement:
a. "I will get a medic alert bracelet that says I'm diabetic taking tolbutamide (Orinase)."
b. "I'm glad I can still have wine with my meals."
c. "If I go outside, I'll stay out of the sun or use sunscreen."
d. "I know that tolbutamide (Orinase) will help control my diabetic condition."


B - Alcohol combined with oral hypoglycemics can trigger a hypoglycemic reaction.


7. Which of the following is the desired response of vasopressin (Pitressin)?
a. lower urine specific gravity
b. lower urine output
c. treat hypotension
d. control polyphagia


B - The goal of vasopressin is to lower urine output; replacement for the ADH hormone.


8. A patient complains of GI distress following administration of vasopressin (Pitressin). The nurse should instruct the patient to:
a. eat crackers after taking the dose
b. take a warm bath to reduce abdominal cramping
c. lie down for 30 minutes following administration
d. drink glass of water with each dose


D - Drinking a glass of water with each dose will decrease GI symptoms.


9. Which statement should be included in a patient's teaching concerning hydrocortisone (Cortisol) therapy?
a. take aspirin to treat fever
b. take hydrocortisone (Cortisol) before meals
c. restrict caffeine and alchol intake
d. restrict potassium intake


C - Hydrocortisone can cause GI distress and even lead to a peptic ulcer with long-term use. Caffeine and alcohol can further increase GI distress and should be restricted.


10. Hydrocortisone (Cortisol) is discontinued gradually to prevent:
a. anaphylaxis
b. diabetic coma
c. adrenal insufficiency
d. cardiovascular collapse


C - Adrenal insufficiency can occur with abrupt removal of corticosteroids. Corticosteroids are gradually discontinued so that the adrenal glands can begin to secrete corticosteroids independently.


11. Before administering levothyroxine (Synthroid) to a patient, the nurse should:
a. check the patient's pulse
b. listen to the patient's chest
c. take the temperature
d. assess the patient's neuro status


A - An adverse effect of levothyroxine is tachycardia; the nurse should check the patient's pulse before administration.


12. A client taking propylthiouracil (PTU) calls the physician's office and complains of chills, fever, and sore throat. Which nursing action is appropriate?
a. Tell the client it sounds like she has the flu and that she should drink lots of fluids, take aspirin, and get extra rest.
b. Tell her to come in immediately for a throat culture and blood work as this may be a serious drug reaction of PTU.
c. Expect the physician to prescribe another thyroid antagonist drug as this is an allergic reaction.
d. Tell the client that these are expected drug reactions and that they will subside in a few days.


B - Symptoms of chills, fever and sore throat while receiving propylthiouracil (PTU) require throat culture and blood work right away.


13. A client calls the gynecology clinic and states she thinks she is pregnant even though she has consistently taken her birth control pills. The nurse tells her to:
a. continue taking the pills and see the physician
b. stop taking the pills and see the physician
c. continue taking the pills and see if menses occurs in the next cycle
d. stop taking the pills for this cycle; wait 28 days and start them again


B - If the client is taking birth control pills and believes she is pregnant, she should stop taking the pills and see the physician.


14. The "minipill" oral contraceptive contains:
a. estrogen
b. progestin
c. estrogen and progestin
d. none of the above


B - The "minipill" oral contraceptive contains only progestin.


15. The nurse sets up a patient's oxytocin (Pitocin) infusion. Which of the following are nursing considerations in caring for clients receiving oxytocin infusions?
a. The nurse should increase the infusion by 23 U/min every 15 minutes until there is a pattern of contractions.
b. Time-tape the solution and use microdrip tubing to monitor the rate.
c. Use an infusion pump and piggyback infusion into primary infusion line.
d. Monitor the client's temperature every 15 minutes.


C - Oxytocin (Pitocin) infusion should be administered on an infusion pump and piggybacked into a primary infusion line to control rate of infusion and to minimize and/or prevent potentially dangerous adverse effects of oxytocin (Pitocin).


16. Which statement concerning methylergonovine (Methergine) is correct? Methylergonovine is given:
a. to induce labor
b. in the first stage of labor
c. after placental delivery
d. IV prophylactically to prevent post-partum hemorrhage


C - Methergine is given after placental delivery because it can cause uterine tetany, and is given IM.

Sunday, January 20, 2008

Drugs: ANS Questions

1. A patient is started out on a low dose level of dopamine hydrochloride (Intropin) IV. Which of the following can the nurse expect?
a. A decrease in glomerular filtration rate
b. A decrease in the force of myocardial contractions
c. An increase in urine output
d. An increase in tactile sensation


C - Dopamine at low doses causes dilation of renal and mesenteric arteries, which in turn causes increased urine output.


2. Which nursing action is NOT appropriate for a patient receiving IV Dopamine hydrochloride (Intropin)?
a. The nurse will monitor V/S frequently
b. The nurse will check the IV infusion site frequently for extravasation
c. The nurse will infuse the drug via macrodrip tubing and will adjust the rate manually
d. The nurse will check client extremities for temperature and color


C - Dopamine needs to be infused via a minidrip tubing and attached to an infusion pump for accurate administration.


3. The patient experiences extravasation at the insertion site of dopamine hydrochloride (Intropin) IV. The infusion is stopped. What should be done next?
a. Warm compresses should be applied to the IV site
b. An ice pack should be applied to the IV site
c. The extremity with the IV site should be elevated on two pillows
d. The IV site should be infiltrated with phentolamine (Regitine).


D - If extravasation occurs with dopamine administration, the IV site should be infiltrated with phentolamine (Regitine) immediately after discontinuing the infusion.


4. When high doses of dopamine hydrochloride are given IV for treatment of shock, what effect would the nurse be looking for?
a. Increased BP
b. Decreased HR
c. Increased RR
d. Elevated body temperature


A - High doses of dopamine hydrochloride stimulate alpha-adrenergic activity, which causes increased BP.


5. Which drug produces effects that closely mimic high doses of dopamine hydrochloride (Intropin)?
a. Atropine sulfate
b. Ephedrine
c. Isoproterenol (Isuprel)
d. Norepinephrine (Levophed)


D - Dopamine given in high doses has effects that closely mimic norepinephrine (Levophed)


6. A woman calls the physician's office and states that she has vomited each time she has taken ergotamine tartrate (Ergomar). The nurse's best response is:
a. "Vomiting is a common A/E. Tell the physician so he can prescribe an anti-emetic for you."
b. "Stop taking the drug immediately. Vomiting is a toxic drug effect."
c. "You must be allergic to the drug. Notify the physician."
d. "Vomiting is a transient effect and it will eventually go away."


A - Ergotamine has emetic effects; vomiting is a common side effect. The client needs an antiemetic to help control this problem.


7. Which group of individuals should not receive ergotamine tartrate (Ergomar)?
a. Diabetic clients
b. Asthmatic clients
c. Alcoholic clients
d. Pregnant women


D - Ergotamine has an oxytoxic effect; it is C/I in pregnant women.


8. The nurse should relate all of the following information about ergotamine tartrate to a patient receiving the medication EXCEPT:
a. take the drug as soon as you feel a migraine headache coming on
b. have your blood pressure checked routinely when taking this drug
c. increase the dose as needed to help control your migraines
d. tell the physician if you have any numbness or tingling in your toes and fingers


C - Ergotamine tartrate is a drug that is abused by clients by altering dosage amount. Only the physician should change
the dose of the drug.


9. When preparing the drug bethanechol chloride (Urecholine) the nurse knows that:
a. IM or IV is the preferred route
b. bethanecol chloride should be given with food
c. breath sounds should be monitored
d. constipation is a frequent A/E


C - Breath sounds should be monitored to assess for wheezing and bronchospasm.


10. Which drug would be given to treat neostigmine (Prostigmine) overdose?
a. Acetylcholine acetate (Miochol)
b. Atropine sulfate
c. Bethanicol (Urecholine)
d. Lidocaine (Xylocaine)


B - Atropine sulfate, an anti-cholinergic is the antidote for neostigmine (Prostigmine).


11. Which of the following effects of atropine sulfate would the nurse expect a patient having this medication exhibit?
a. Dry mouth
b. Increased bronchial secretions
c. Tachycardia
d. Miosis


A - Atropine sulfate causes dry mouth and decreases secretions, which is why it is given as a pre-anesthetic.


12. Which statement indicates that the client needs more teaching concerning the use of atropine sulfate?
a. "I will brush my teeth and see my dentist regularly."
b. "I will eat low-residue foods to prevent diarrhea."
c. "I will take my medication at least a half hour before meals."
d. "I will stay in my air conditioned house on hot and humid days."


B - Atropine can cause constipation; high-fiber foods and fluids should be encouraged.


13. Which adverse effect would the nurse NOT expect to see with trihexyphenidyl HCl (Artane) therapy?
a. Dizziness
b. Dry mouth
c. Diarrhea
d. Suppression of sweating


C - Artane is an anti-cholinergic that can cause constipation, not diarrhea.


14. A patient has symptoms that are not improving, so the physician starts her on levodopa (Larodopa) as an adjunct with trihexyohenidyl HCl (Artane). Which statement by the patient indicates understanding of proper use of levodopa (Larodopa)?
a. "If symptoms get worse I will stop taking this drug."
b. "I will not eat liver or boxed cereals."
c. "If I have a cold I will take aspirin or a cold remedy."
d. "I will eat eat foods low in residue to prevent diarrhea."


B - Vitamin B6 (pyridoxine) reverses the therapeutic effects of levodopa (Larodopa); clients should restrict their intake of foods high in vitamin B, such as whole-grain cereals, fortified cereals, liver and green vegetables.


15. Which instruction should the nurse give to clients taking bromocriptine (Parlodel)?
a. "Take one hour before meals."
b. "Do not use birth control pills as contraceptives."
c. "This drug causes infertility and use of contraceptives will not be necessary."
d. "Adverse effects will be reduced if taken during the day."


B - Oral contraceptives antagonize the effects of bromocriptine (Parlodel). Another method of birth control should be used.

Thursday, January 10, 2008

Drug Salad

ACE INHIBITORS

- It lowers blood pressure by stopping the angiotensin converting enzyme in the lung, which reduces the vasoconstrictor, angiotensin II. In other words, when you are playing cards, you may block the aces so your opponent will not win. This indeed will lower your blood pressure:

How do I remember all of these medications?

It's actually insanely easy!!! Remember they are pills and if you put an R after the P, you have a PRIL; these medications all end in PRIL.

Captopril
Enalapril
Lisinopril
Fosinopril
Ramipril
Benzaepril

What do I need to evaluate?
1. Blood pressure - since these meds reduce vasoconstriction, the pressure may go down too low. Observe for dizziness and/or tachycardia.
2. Some undesirable effects include an annoying dry cough, angioedema of the face, lips, tongue and pharynx. Uncommon side effects include rash & taste disturbances.
3. Monitor for hyponatremia and hyperkalemia
4. With Captopril, agranulocytosis or neutropenia may occur (ask about sore throats).

ALLOPURINOL (ZYLOPRIM)
Allopurinol (Zyloprim) is the DOC to prevent GOUT, decreases uric acid synthesis. Uric acid is the end product of purine metabolism. Condition of hyperurecemia may also occur in individuals receiving chemotherapy (secondaray gout). Meds for an acute attack may include colchicine, indomethacin (Indocin), or naproxen (Naprosyn).

Gout is generally rapid with swelling and a painful joint. Typically the uric acid crystals are in the large toe, but may also involve ankles and knees. During an acute attact, protect the affected joint by immobilizing the joint. Encourage gradual weight reduction. Instruct the client to avoid salicylates. Encourage high fluid intake (>3L/day) to increase excretion of uric acid & to prevent the development of uric acid stones.

Teach clients to avoid foods high in purines such as organ meats, shell fish, and preserved fish (anchovies, sardines) and avoid alcohol. We would like to see the urine output increased to 2 liters per day to help decrease the risk of stones. Clients at risk for stones may be given trisodium citrate for urine alkalinization.

Remember - clients with renal insufficiency should receive a reduced dose of Allopurinol.

G - Gulp 3 liters of fluid per day
O - Organ meats or wines not allowed
U - Urine output increased to 2 liters/day
T - Teach

AMINOPHYLLINE TOXICITY
Aminophylline (bronchodilator) is a wonderful & effective drug that relaxes & expands the bronchi reversing airway obstruction. This drug is commonly used in clients with problems such as: asthma, croup, chronic bronchitis & COPD.
Story: A girl named, Amily Toxicity received too much of this drug. We recommend that you stay out of her way! When she gets too much of this wonder drug, she THROWS UP. Amily has an "A" on her name for "hyperACTIVITY". When the level gets high, Amily starts bouncing off the walls. The "T" is for "TACHYCARDIA". Amily is so active that her heart rate must race (tachycardia) to keep up with her.

The therapeutic range for aminophylline level is 10-20 mcg/ml.
*Keep your eyes open, and your assessments will tell you the story about the effectiveness of this drug. If signs of toxicity occur, report to the provider or check the TBL.

ANTACIDS
Mag has had a history of an ulcer, but feels much better now since antacids coat her stomach lining. She, however, has developed another serious problem with DIARRHEA!!!! This is a major side effect of antacids containing magnesium such as Milk of Magnesia. The diarrhea must get under control or she will need to meet ALKALI, a cousin, which will assist her in correcting the metabolic acidosis which may occur as a complication from the diarrhea. Mag should be monitored for dehydration, hypokalemia, hyponatremia. If Mag were to remain on magnesium oxide for prolonged therapy, the magnesium level should be monitored periodically.

AL is also in the family and is taking an aluminum antacid such as amphogel for his ulcer symptoms. As you can see, Al's problem is constipation. He is so full of it that he can't get rid of it. CONSTIPATION is a major side effect of antacids containing aluminum.

Remember - Teach clients to take antacids one hour after meals and to refrain from taking other oral medications within 1-2 hours of any antacid.

ANTI-ANXIETY
Clients who are anxious may feel like they are going 'BATS". These BATS will assist you in remembering these anti-anxiety drugs:

B - BETA ADRENERGIC BLOCKERS may be used for a rapid heart rate
- BENZODIAZEPINES such as alprayalam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) and others decrease anxiety by depressing the limbic and subcortical central nervous system.
A - ANTIHISTAMINES such as hydroxyzine (Atarax) may decrease anxiety if the client is a potential abuser of benzodiazepines.
T - TRICYCLICS and MAO inhibitors may be used for panic attacks.
S - SSRI's may be effective in managing anxiety

ANTI-COAGULANTS
Coumadin and Heparin are used to inhibit thrombus and clot formation. They chip away at the clot to make it smaller. Clotting times will be prolonged which will assist in maintaining the flow or "stream of blood."

The key to successfully remembering the lab reports and antidotes for the appropriate anticoagulants are to think of (H) looking like 2 tt's in Heparin. The lab report necessary to evaluate while clients are on heparin is Ptt. The antidote has also 2 t's in it (protamine sulfate).

Coumadin's antidote is vitamin K. C and K sound alike which help with association. The lab report which needs to be monitored is Pt.

Labs now report INR (international normalized ratio) values. The range for most clients on anticoagulants is 2-3. The exceptions are mechanical heart valves and recurrent thromboembolism clients who should be anticoagulated to an INR of 3-4.5.

ANTICHOLINERGICS
The major side effects of these medications are easily seen below. Some examples of these medications include: Atropine, Methantheline (Banthine), and Dicyclomine hydrochloride (Bentyl). Of course, these drugs are given because of the desirable effects of decreasing salivation, lacrimation, urination, diarrhea and GI motility. Blurred vision and dilated pupils are also side effects. It's when we get too much that we get in trouble.

4 CAN'Ts: (Side Effects)
CAN'T PEE
CAN'T SEE
CAN'T SPIT
CAN'T SHIT
Remember - These meds are contraindicated in closed an open angle glaucoma, prostatic hypertrophy and obstructive bowel disease.

BETA-BLOCKERS
Beta blockers are a group of drugs that can be remembered using the acronym BETA. People taking these drugs may need TLC.

B - BRONCHOSPASM (so we don't want to give them to people with asthma or bronchoconstrictive disease!).
E - ELICITS A DECREASE IN CARDIAC OUTPUT AND CONTRACTILITY
T - TREATS HYPERTENSION
A - AV CONDUCTION DECREASES (short for treats arrhythmias, especially fast ones by decreasing the heart rate and cardiac output!)

REMEMBER STOP BETA-BLOCKERS WITH BRONCHOCONSTRICTIVE DISEASES.

T - TENORMIN (atenolol) used for hypertension and angina (watch for renal impairment as this drug is renally excreted)
L - LOPRESSOR (metoptolol) used for hypertension and angina (C/I in sinus bradycardia, 2nd or 3rd degree block, metabolized in liver and NOT renally excreted).
C - CORGARD (nadolol) used for hypertension and angina ( renally excreted, C/I in bronchial asthma, sinus bradycardia or 2nd or 3rd degree heart block).

CALCIUM CHANNEL BLOCKERS
This group of medications are often called "Don't Give a Flip Pills" by the clients who take them because that's exactly how they feel. Their blood pressure is lowered (calcium influx blocked), pulse is decreased, and if they move too quickly they get dizzy. They are much happier being a couch potato and taking life easy. A few examples of the calcium channel blockers include Cardizem, Cardene, Procardia and Calan. Each of these common Calcium Channel Blockers have a Ca in them which makes it easy to remember! These medications should be administered with meals and milk. Some general undesirable effects of these medications include constipation, bradycardia, peripheral edema, hypotension, dizziness, heart blocks, and worsening of CHF.

Remember - Calcium Channel blockers should not be given in clients who are in CHF or cardiogenic shock because they can decrease the heart rate too much.

LOOP DIURETICS
Lou la Bell has been given a loop diuretic such as Lasix or Ethacrynate Sodium and is very dizzy. Her blood pressure has decreased too much after her excessive peeing. You would also feel as if you were spinning in a tube over the falls if you lost this much urine (volume). It may be very useful to teach her to get up slowly so she won't fall.

The life guard must blow his whistle in order to get her some assistance. She feels that the ringing in her ears just won't go away. Dizziness and ringing in the ears are major adverse effects from loop diuretics.

A few other adverse reactions include : hypokalemia, hypocalcemia (tetany), hyperglycemia, and hyperurecemia. While aplastic anemia and agranulocytosis may occur, they are RARE!

Remember - Keep a close watch on blood pressure, potassium and calcium levels. Teach foods high in potassium and calcium. Potassium supplements may be necessary.


DILANTIN
(DIAL AT TEN)
Dilane has a seizure and is taking the drug dilatin. She does not feel well and is calling the nurse at 10:00am. Her therapeutic level for Dilantin should be 10-20mcg/ml (EASY TO REMEMBER. THERE IS A TIN (TEN) IN DILANTIN). Her adverse reactions from this medication include gingival hyperplasia, GI disturbances, hepatotoxicity, ataxia, hypocalcemia, & decrease in absorption of Vit. D (milk and sunshine will help this problem).
If Dilane's level becomes toxic, be sure to inform the provider. The drug will likely be decreased.
Remember - Teach good oral hygiene and nutrition.


NSAIDs
NSAIDs are a group of medications that prevent prostaglandin synthesis.
What does it mean? Prostaglandins contribute to the following: inflammation, body temperature, pain transmission, platelet aggregation and other actions. These prostaglandins are not stored, but are released on demand.
What type of physical problems may benefit from NSAIDs? Fever and inflammation (ie. arthritis) can be reduced by these medications.
Are there any undersirable effects from NSAIDs? There are several undesirable effects that the nurse mus assess and educate clients to report. These include GI upset or bleeding, ototoxicity (ringing of the ears), hepatic necrosis, or nephritis.
As a nurse, what should be included in the plan of care?
1. Administer medications with food to decrease GI irritation.
2. Teach clients about actions and side effects and report any dark, tarry stools, "coffee ground or bloody emesis", other GI distress or ringing of the ears.
3. Instruct client to inform health care providers about these medications prior to any dental or otehr type of surgery. NSAIDs should be discontinued approximately 5-7 days before the procedure to prevent any complications of bleeding.
4. NSAIDS are not the drugs of choice if the client has any compromise in either the renal or the liver.
5. Evaluate the effectiveness of the NSAIDs.


PITOCIN
Pitty Pitocin, this pregnant woman, is slow to begin active labor, so the Doc decides to induce by using PITOCIN. Watch for those major side effects!
Visualize Pitty sitting in a row boat looking into a PIT watching the "TETANIC" sink into the ocean" (OCIN). Complications of this drug are TETANIC CONTRACTIONS. Pitocin of course is a stimulant; so as Pitty watches the ship sink, her PRESSURE elevates! Just as a sinking ship takes in all that salty WATER, poor Pitty is left holding the excess fluid in her body (observe I & O). She gets so nervous with all this happening that she goes into CARDIAC ARRHYTHMIAS causing Pitty's baby OXYGEN hunger and FETAL HEART IRREGULARITIES. This is so upsetting to Pitty that she gets NAUSEATED and VOMITS all over the row boat.
STOP THAT PITOCIN DRIP!!!!


TYLENOL (ACETAMINOPHEN OVERDOSE)
A major undesirable effect of tylenol overdose is hepatic necrosis. It is like we have taken a hammer and beaten "the hell out of the liver". The dose of tylenol should not exceed 4g/day. Other side effects are negligible with recommended dosage. With acute poisoning, the following adverse effects may occur: anorexia, nausea and vomiting, epigastric or abdominal pain, HEPATOTOXICITY, hypoglycemia, and hepatic coma.
Tylenol (Acetaminophen) is a very useful drug for pain and fever. (Refer to Poison Control for more specific plans).
Remember - Do not administer to clients with liver disease.

Sunday, January 6, 2008

Drugs: CNS Questions

1. Which adverse effect would the nurse NOT expect to observe in a client receiving a narcotic analgesic?
a. Urine retention
b. Constipation
c. Hypoglycemia
d. Hypotension

Ans: An A/E of narcotic analgesics is hyperglycemia. The nurse would not expect to see hypoglycemia.

2. Which assessment by the nurse is most important before administering meperidine (Demerol) to a patient?
a. Apical pulse rate
b. Respiratory rate
c. Blood pressure
d. Level of consciousness

Ans: Respiratory rate needs to be assessed before giving the client a narcotic as it can have a life-threatening effect.

3. Which client should have cautious use of naloxone hydrochloride (Narcan)?
a. Meperidine (Demerol)
b. Brittle diabetic
c. Asthmatic
d. Post-op radical neck

Ans: The client will experience withdrawal syndrome if naloxone is given to a client who is addicted to narcotics. Thus, narcotic addicts should use this drug cautiously.

4. What other drug is added to local anesthetics?
a. Epinephrine
b. Demerol
c. Atropine
d. Quinidine

Ans: Epinephrine is added to prolong anesthetic action, while shortening the onset of action and reducing blood flow to injection site.

5. Which of the following is a common complaint in a patient who is taking prescribed viscous lidocaine (Xylocaine) after a tooth extraction?
a. mouth sore
b. dryness of lips
c. sore throat
d. numbness of the tongue

Ans: Sore throat is a common complaint in patients taking viscous lidocaine because it can interfere with swallowing reflex and clients should at least wait 60 minutes after use before eating.

6. What A/E of pentobarbital (Nembutol) should you NOT include during a client education of the drug?
a. Respiratory depression
b. Anxiety and hand tremors
c. Hypotension and bradycardia
d. Dry mouth and urinary retention

Ans: A/E of pentobarbital do not include dry mouth and urinary retention. These effects are more typical of an anticholinergic drug.

7. Which group should not receive barbiturates?
a. Children <5>
b. Pregnant women
c. Nursing mothers
d. Adults with bleeding ulcers

Ans: Barbiturates are teratogenic and are contraindicated for pregnant women.

8. What should the nurse teach a child patient and her family to watch for a common adverse effect of phenytoin (Dilantin)?
a. Alopecia
b. Edema
c. Gingival hyperplasia
d. Hallucinations

Ans: Gingival hyperplasia is a common A/E of this drug, seen mostly in children and adolescents.

9. What is the drug of choice for status epilepticus?
a. Phenytoin (Dilantin)
b. Carbamazepine (Tegretol)
c. Phenobarbital (Luminal)
d. Diazepam (Valium)

Ans: Diazepam (Valium) is the DOC for status epilepticus

10. Which statement by a client indicates a need for more teaching about baclofen (Lioresal) by the nurse?
a. "I'll take my pills with my meals"
b. "I'll drive myself to work each day"
c. "I won't have wine with dinner anymore"
d. "I'll use sunscreen when I go outside"

Ans: Due to the depressant effects of this drug, the client should not engage in any potentially dangerous activities (driving or operate machinery) until the client response to the drug is known.

11. The nurse should handle carefully chlorpromazine (Thorazine) to be given to a patient IM to prevent:
a. Skin discoloration
b. Skin irritation
c. Headache
d. Dizziness

Ans: Handling the parenteral or liquid forms of chlorpromazine may cause contact dermatitis.

12. Which of the following interventions should be included in a patient's care plan concerning chlorpromazine (Thorazine) therapy?
a. Supervise ambulation
b. Take a hot bath to reduce agitation
c. Restrict fluid intake to prevent edema
d. Discontinue drug if sedation occurs

Ans: This drug can initially cause orthostatic hypotension; ambulation should be supervised to prevent falls until tolerance develops.

13. Which phenothiazine is used specifically as an antiemetic and rarely causes EPS?
a. Thioridazine (Mellaril)
b. Fluphenazine (Prolixin)
c. Promethazine (Phenergan)
d. Chlorpromazine (Thorazine)

Ans: Promethazine (Phenergan) is used as an antiemetic and rarely causes EPS.

14. Which antipsychotic agent is also used to treat Tourette's syndrome and causes less sedation than other phenothiazines?
a. Haloperidol (Haldol)
b. Thioridazine (Mellaril)
c. Fluphenazine (Prolixin)
d. Chlorpromazine (Thorazine)

Ans: Haloperidol is also used to treat Tourette's syndrome and causes less sedation.

15. Which of the following should be included in a client's teaching taking imipramine (Tofranil)?
a. Expect to see improvement of depression in 2-3 days
b. Stop taking drug if dizziness occurs
c. Do not drive or operate machinery
d. Take drug on an empty stomach

Ans: Imipramine can cause drowsiness; therefore the client should avoid driving and operating machinery.

16. When should a client expect to see improvement of depression while on impramine (Tofranil)?
a. 1-2 days
b. 1 week
c. Several weeks
d. Immediately after first dose

Ans: It takes several weeks (2-4 weeks) before seeing improvement of depression.

17. Which food/beverages should a client avoid while taking phenelzine (Nardil)?
a. Cheese
b. Apples
c. Pasta
d. Cereal

Ans: Foods such as cheese that contain tyramine or tryptophan should be avoided while taking MAO inhibitors to prevent hypertensive crisis.

18. Which statement by a client indicates a need for more teaching by the nurse concerning flouxetine (Prozac) therapy?
a. "I will take this medication in the morning"
b. "I will use calamine lotion if I get a skin rash"
c. "It will take a month before I feel better"
d. "I will check with my doctor before I take any other medications"

Ans: A skin rash resulting from use of flouxetine indicates an allergic reaction and should be reported to the provider immediately.

Drugs: Contemporary

CO-ENZYME 10
- Has antioxidant and membrane stabilizing properties
- Q10 is a free radical scavenger
- Protects cell membranes and DNA from oxidative damage
- Found in all human cells
- Protects tissue from cellular damage

INDICATIONS
Allergies
Asthma
Respiratory disease
Alzheimers’ disease
Schizophrenia
Gives energy to the heart especially in CHF

UNDESIRABLE EFFECTS
Anorexia
Nausea
Diarrhea
Epigastric discomfort

SPECIFIC INFORMATION

Oral antidiabetic agents may decrease effectiveness of Co-Q10
Co-Q10 may decrease response to warfarin

INTERVENTIONS
Cardiovascular assessment should be ongoing
Coenzyme Q10 is oil soluble and is best absorbed when taken with oily or fatty foods such as fish

EDUCATION
Co-Q10 is perishable and deteriorates in temperatures above 115’F
A liquid form or oil form is preferable
Vitamin E helps preserve Co-enzyme

FOODS HIGH IN VITAMIN E
Mackerel, salmon, sardines
Peanuts
Spinach
Beef

EVALUATION CLIENT WILL HAVE NO SIGNS OF:
Peripheral edema, hepato-splenomegaly, bibasilar crackles
Client will have normal sinus rhythm on ECG
Increased sense of well-being

BRANDS
ADELIR
CO-Q10
HEARTACIN
INOKITON
NEUQUINONE
TAIDECANONE
UBIQUINONE
UDEKINONE

ECHINACEA
- Stimulates phagocytosis
- Increases mobility of leukocytes
- Increases respiratory cellular activity
- Increased immunity
- Antiseptic, antiviral, anti-inflammatory
- Has peripheral vasodilator property

INDICATIONS
Sore throat, colds, flu, low immune status, CA
Ointments used for burns, ulceration, eczema, herpes simplex, psoriasis
Reduces recurrence of Candida Albicans
Decreases growth of Trichomonas Vaginalis

WARNINGS
EXTERNALLY: none
INTERNALLY: TB, MS, HIV, collagen diseases and autoimmune diseases
Alcoholics and with liver disease
Pregnancy, breastfeeding
Children

UNDESIRABLE EFFECTS
Allergies may occur if client is allergic to plants in the daisy family.

OTHER SPECIFIC INFORMATION
Do not administer with immunosupressants or hepatotoxic drugs, or with disulfiram and metronidazole)

INTERVENTIONS
Monitor WBC
Vital signs
Breath sounds

EDUCATION
- Instruct the client that herb should not be used longer than 8 weeks ,10-14 days of therapy is probably sufficient
- If illness does not resolve after taking the herb, advise to notify provider.

EVALUATION
WBCs will return to normal range.Temperature will return to normal range, and client will have a decrease in the symptoms for which the herb was administered.

BRANDS
CONEFLOWER EXTRACT
ECHINACEA
ECHINACEA ANGUSTIFOLIA
ECHINACEA FRESH FREEZE-DRIED
ECHINACEA GLYCERITE
ECHINACEA PURPUREA

EVENING PRIMROSE
- Its oil stems from essential fatty acids that are crucial as structural elements for cells as precursors of synthesis of prostaglandins
- Linoleic acid is not manfactured by the body and must be provided through diet
- The body relies on the metabolic conversion of lenoleic acid (LA) to gamma lenoleic acid (GLA). A deficiency in this process results in diabetes , CA, CVD.
- This herb contains the highest amount of GLA .

INDICATIONS
Rheumatoid arthritis
PMS
Menopause
diabetic neuropathy

WARNINGS
Pregnancy
Breast CA
Schizophrenia
Clients taking epileptogenic meds such as penothiazines

UNDESIRABLE EFFECTS
Abdominal discomfort
Nausea
Headache
Rash
Immunosuppression may occur after use of GLA > 1year

OTHER SPECIFIC INFORMATION
Penothiazines may increase risk of seizures

EDUCATION
Instruct women with breast CA or clients with seizure disorder not to use this herb

EVALUATION
The client's symptoms will improve based on therapeutic reason for taking the herb

BRANDS
EFAMOL
EPOGRAM
EVENING PRIMROSE OIL
PRIMROSE POWER
MEGA PRIMROSE OIL

FEVERFEW
- Inhibits synthesis of prostaglandins and leukotrienes
- Inhibits secretion of serotonin from platelet granules

INDICATIONS

Migraine headaches
Arthritis
Fever
Menstrual disorders

UNDESIRABLE EFFECTS
Occasional mouth ulceration
GI disturbances
Dry, sore tongue
Swollen lips
Abdominal pain
Vomiting
Diarrhea, flatulence

POST FEVERFEW SYNDROME
Withdrawal syndrome characterized by moderate to severe pain and joint and muscle stiffness

OTHER SPECIFIC INFORMATION
Use caution with anti-coagulants, may increase bleeding

INTERVENTIONS
Recommend avoiding chewing the leaves since they can cause mouth ulcers

EDUCATION
- Discuss proper oral hygiene due to the risk of mouth ulcerations.
- Discuss the importance of reporting undesirable effects to provider
- Even feverfew is given for pain, the user can still operate heavy machinery
- Treatment for at least a few months is recommended .
- Instruct the client not to withdraw the herb abruptly.

EVALUATION
Clients temperature will return to normal range and pain subside.

BRANDS
FEVERFEW
FEVERFEW GLYC
FEVERFEW POWER

GARLIC
- Inhibits platelet agreggation
- Decreases lipids
- Has anti-tumor effects
- Lowers total serum cholesterol, TG, and LDL
- Increases HDL
- Anti-microbial

INDICATIONS
Lowers high blood pressure and serum lipid levels
Aids in treatment of arteriosclerosis
Aids in treatment of yeast infection, wounds, colds and flu

WARNINGS
Hypersensitivity
Peptic ulcer or reflux disease
Pregnant women due to oxytoxic effects

UNDESIRABLE EFFECTS
The entire body can smell of garlic
Diaphoresis
Hypothyroidism
Irritation of the mouth, esophagus or stomach
Nausea and vomiting
Chronic use may lead to decreased hemoglobin production and lysis of RBCs

OTHER SPECIFIC INFORMATION
Increases the risk of bleeding

INTERVENTIONS
Monitor CBC if client taking high-dose or long term

EDUCATION
Odorless garlic supplements are available
Instruct client watch for signs of bleeding (bleeding gums, petechiae) if taking with hemostatic agents

EVALUATION
The client will have a decrease in BP, lipid levels, or clinical symptoms for which the garlic was administered

BRANDS
GARLIC POWER
GARLIQUE
KWAI
ODORLESS GARLIC TABLETS
ONE A DAY GARLIC
APEC

GINKGO BILOBA
- Produces arterial and venous vasoactive changes that increase the tissue perfusion and cerebral blood flow
- Stimulates prostaglandin biosynthesis
- Acts as anti-oxidant

INDICATIONS
Memory loss
Early stages of Alzheimers’ disease
Poor circulation to extremeties
Intermittent claudication

WARNINGS
Hypersensitivity
Pregnancy
Children
Hemophilia or bleeding disorders
Clients taking anti-coagulants and anti-platelet meds

UNDESIRABLE EFFECTS
- Mild GI upset in less than 1% of patients
- Long term use has been linked with rare occurrence of spontaneous subdural hematoma, intracerebral or intraoccular hemorrhage

OTHER SPECIFIC INFORMATION
Cigarette smoking or use of platelet agreggation inhibitors increases the risk of subarachnoid hemorrhage, may interact with carbamazepine, phenobarbital and phenytoin.

INTERVENTIONS
Administration for at least 2 weeks recommended
Children and adults taking medicinal doses should be seen by a qualified health care provider

EDUCATION
- Stay within recommended dosage and duration. Advise not to take aspirin or - NSAIDs or alcohol; report unusual bleeding or bruising.
- Keep out of reach from children due to potential risk of seizures with ingestion
- Avoid contact with the fruit pulp or seed coats due to risk of dermatitis

EVALUATION
Substantial regression of major symptoms of chronic cerebral insufficiency including vertigo, senility, fatigue, lack of vigilance, and poor circulation to the limbs

BRANDS
BIOGINKO 24/6
BIOGINKO 27/7
GINCOSAN
GINEXIN REMIND
GINKAI
GINKOBA
GINKO PHYTOSOME

GINSENG
- Supports and enhances adrenal function , allowing for more consistent energy and better reaction to stress.
- Reduces cholesterol and TG, decreases platelet adhesiveness and coagulation increases fibrinolysis
- Antiarrhythmic effects have also been determined with ginseng similar to verapamil and amiodarone

INDICATIONS
- Improves stamina, concentration and stress-resistance; adjunct in radiation and chemotherapy.
- Lowers blood glucose and cholesterol levels
- Has anti-hypertensive effects

WARNINGS
Cardiovascular disease
Hyper/hypotension
Diabetes
Steroid therapy
Pregnancy
Breastfeeding

UNDESIRABLE EFFECTS
High doses can cause jitters, headache, hypertension, vaginal bleeding, skin eruptions and pruritus.

OTHER SPECIFIC INFORMATION
- Anti-diabetic agents should be used cautiously due to ginseng's hypoglycemic effect.
- MAO inhibitors given with ginseng may result in tremors, headache and mania.
- Herb may interfere with digoxin effects

INTERVENTIONS
- Monitor for “Ginseng Abuse Syndrome” (nervousness, insomnia, morning diarrhea)
- This will occur if tea or coffee are taken with the herb.
- Monitor the diabetic client for signs and symptoms of hypoglycemia.

EDUCATION
Take 1 hour before eating.
Vitamin C can interfere with absorption.
Avoid caffeine
Take early in the day to reduce over stimulation.
Generally up to 3 months is recommended

EVALUATION
Client will experience an increase in energy and an improvement of symptoms for which ginseng was administered.

BRANDS
BIOSTAR
CIMEXON
GINCOSAN
GINSANA
GINSATONIC
NEO GINSANA

KAVA - KAVA
- The limbic system is inhibited by kavapyrones an effect associated with suppression of emotional excitability and mood enhancement. Noted for promoting relaxation without loss of mental sharpness

INDICATIONS
Anxiety disorders
Stress
Insomnia
Muscle spasms
Backache
Neckache
Pain from TMJ

WARNINGS
Pregnant,breastfeeding
Children