ATI Virtual- Pharm Assessment

Diclofenac is an NSAID, how should it be taken?

with food or milk (gastric irritation)

should take with antacid to minimize irritation

Gastric ulcer taking esomeprazole, what information in teaching?

take med 60min before meals

food affects absorption of this med

Furosemide teaching?

-eat foods high in potassium

-report hearing loss (ototoxic drug)

-rise slowly from sitting/lying position

-take early to prevent nocturia

-check wt daily

Methylprednisolone (corticosteroid)- what lab values to monitor?

glucose

decreases uptake=^circulating BG

Epoetin alfa- what lab tests to determine effectiveness?

-hemoglobin (should not be higher than 10mg/dL= stroke, HF, MI, HTN)

-iron (in the hemoglobin)

Heparin continous IV for venous thrombosis- what lab value to titrate dose?

aPTT q4-6hrs, then daily when at desired range

What lab values for warfarin therapy?

INR

TB and taking rifampin, what statement indicates understanding?

"I shouldn't wear my soft contact lenses, because they will become discolored"

-This medication causes red-orange discoloration of feces, sputum, tears and sweat.

-take on empty stomach w/8oz of water

-nephrotoxic drug

Gout and prescription for allopurinol, which statement to explain how medication helps relive manifestations?

"it decreases the production of uric acid"

this improves joint function

-^daily fluid intake to 2L to reduce risk of renal injury

Prescription for acyclovir X3 daily, what nurse action?

assess for increase in creatinine

-can cause reversible nephrotoxicity

-monitor BUN & creatinine lvls

-encourage ^fluid intake during and after infusion

Taking warfarin following orthopedic surgery- what lab to report to provider?

INR 5.2

(INR 2.0-3.0)

>5= critical value

Acetazolamide, what findings is an adverse effect?

electrolyte imbalance

-promotes real excretion of sodium and potassium

Psuedoephedrine orally for allergic rhinitis, assess for what adverse effect?

HTN

-causes vasoconstriction

Spironolactone, what adverse effects to include in teaching?

muscle weakness

-indicates hyperkalemia (adverse effect of potassium-sparing diuretics)

-this can lead to life-threatening dysrhythmias and cardiac arrest

Tamoxifen for breast cancer, what interventions included in plan?

-monitor calcium lvls (^r/o hypercalcemia)

-monitor for PE (^risk)

-advise about potential menstrual irregularities

-advise of potential for hot flashes (reversible after discont of med)

Ciprofloxacin, what adverse effects included in teaching?

phototoxicity

-most fluoroquinolones cause phototoxicity (sensitivity to light), avoid direct sunlight, wear sunglasses, sunscreen and protective clothing; stop taking immed if occurs

Didanosine therapy- what client condition is indication for use?

HIV

-must take simultaneously w/other antiretroviral meds to reduce r/o resistance to med

Postop from orthopedic sx rcving IV ketorolax (NSAID), what finding is priority to report?

Oliguria

-greatest risk is renal insufficiency/toxicity

Androgen to treat endometriosis, monitor for what adverse effect?

edema

-can cause fluid retention, use cautiously in cardiac/renal impairment- can cause htn, mi, tachycardia and palpitations, wt gain

Ingested toxic amt of acetaminophen 36hrs ago, what finding to monitor?

-diaphoresis

-abd discomfort

-ALT lvl (rises w/liver inflammation from acute toxicity)

(late manifestations 48-72hrs later can show liver failure)

Parkinson's taking levodopa/carbidopa and has tremors and twitching, whih meds should the nurse anticipate administering?

amatadine

-med causes ^risk for developing dyskinesias (invol mvmts); amantadine helps by increasing release of dopamine

Accidentally doubled last dose of diazepam, after assessing- what meds should nurse plan to admin?

flumazenil

(reverses effects of benzodiazepines)

Oral albuterol for long-term mngmt for asthma- what adverse effects to monitor?

tachycardia/dysrhythmias

-albuterol is beta2 agonist causing excessive stimulation of cardiac/skeletal muscle beta cells

Haloperidol for schizophrenia, what adverse effect to monitor for?

muscle rigidity

med can cause extrapyramidal effects (parkinsonism= tremors, bradykinesia, loss of balance, mask-like facial expression, shuffling gait and muscle rigidity)

Ventricular dysrhythmia and new prescription for amiodarone, what interventions in plan of care?

Have liver enzyme testing periodically

(can be toxic to liver- report jaundice)

Postmenopausal and prescription for raloxifene, what is it prescribed for?

reduces r/o breast cancer

Used in postmenopausal pts w/high risk of breast cancer and reduces risk/treats osteoporosis)

Ipatropium inhaler for COPD bronchospasms, what adverse effect to monitor for?

xerostomia (dry mouth)

-drink fluids, chew sugarless gum, sugarless hard candy

Taking lovastatin and new prescription for ezetimibe to lower cholesterol lvls, what lab values to monitor?

ALT

-client who is taking both a statin med and ezetimibe has ^r/o liver damage

T/F: q.d. is an acceptable abbreviation

false; can be mistaken for q.i.d.

Presence of food will alter rate of which pharmacokinetic process?

absorption

Child w/prescription for somatropin, which intervention to evaluate therapeutic effect?

monitor child's ht monthly

-treats growth hormone deficiency; monitor ht and wt monthly

Beclomethasone and albuterol inhaler new prescription, what teaching?

gargle w/water after using beclomethasone

-can ^r/o candida infections, shake prior to use, used for long-term control NOT during an acute attack; use albuterol for acute attack; use albuterol first to promote bronchodilation and increase absorption of beclomethasone

Midazolam during colonoscopy- BP decreases which med?

flumazenil

Sodium polystyrene sulfonate- what lab is therapeutic response?

potassium 4.8

-treats hyperkalemia

Codeine 60mg PO q 4hrs to suppress cough- what is priority finding?

agitation

-can indicate neurotoxicity from overuse of opioid

Rcvd clonidine vs clonazepam, after checking BP, what action first?

review possible adverse effects of clonidine

-first analyze potential risks (can reduce further harm)

Teaching to adolescent for cromolyn for asthma, what statement indicates understanding?

"I'll use med everyday even when I have no symptoms"

-can take within 1hr prior to physical activity, ideally 10-15min prior

Postive Trousseau's sign- what med to admin?

calcium gluconate

-indicates hypocalcemia

Topotecan IV for metastatic ovarian cancer- which meds to control adverse effects?

granisetron via transdermal patch

-helps prevent N/V in pts rcving chemotherapy meds; wear on upper outer arm up to 48hrs prior to rcving med and continue to wear for 24hrs after completion of med

Warfarin and INR of 4, which med?

vitamin k

-reverses effect (^3INR= r/o hemorrhage)

What reverses heparin?

protamine sulfate

IV furosemide for peripheral edema, what findings indicates development of dehydration?

urine output of 240ml in 12hr period

-BP only is systolic is below 90

Prior to admin of atenolol, apical heart rate is 61, what nurse action?

administer

-less than 50HR, withhold and notify provider

Chemotherapy and ondansetron to control N/V, what teaching?

additional meds may be required (+dexamethasone)

-can cause fatigue, dizziness, drowsiness; ^r/o falls

Contraindication of metformin?

alcohol use disorder

-can inhibit breakdown of lactic acid= lactic acidosis; peptic ulcer disease is NOT contraindication

Priority assessment prior to giving meperidine?

RR

-opioid med for mod to severe pain

^in migraine headaches over X2wks and asks if sumatriptan would be helpful- what conditions are contraindicated?

angina pectoris

-vasoconstrictor

New prescription for clopidogrel after coronary artery stenting- what med to report pt is currently taking?

client is taking ginko biloba

-can suppress coagulation, can increase r/o bleeding w/clopidogrel to include chamomile, feverfew and ginseng

Mannitol IV infusion, what finding is expected outcome?

improved urinary output

-osmotic diuretic

Heart failure lab?

BNP

Hydromorphone toxicity- what prescription?

nalaxone

-reverses opiates

Taking ethinyl estradiol and norethindrone for contraception- what manifestation as adverse effect of this combination?

breakthrough bleeding

Penicillin IV- what adverse effect is priority to monitor after admin?

laryngeal edema

-req trmt w/epinephrine

MI and getting thrombolytic therapy with IV alteplase, what intervention in plan of care?

monitor for LOC changes

-bleeding most common adverse effect- LOC changes can indicate intracranial hemorrhage

Ovarian cancer and taking paclitaxel- what finding is priority for nurse to report?

bradycardia

-ABC approach; can cause bradycardia/hypotension

-can cause alopecia, muscle pain, nausea; bradycardia/hypotension is priority