Pharm+HESI+Review

Pharm Hesi Review

Diabetes Management

  • Newly diagnosed clients stabilized on insulin therapy should receive specific educational points during discharge.

    • Dietary Modification: Clients are misled if told there is no need to modify dietary choices once insulin therapy is initiated.

    • Insulin Injection Sites: It is crucial to rotate injection sites systematically to allow for less tissue damage and more effective insulin absorption.

    • Blood Glucose Monitoring: Clients should always verify blood glucose levels before administering insulin.

    • Medication Continuation: Prior medications for hypertension or hyperlipidemia should not be stopped without medical advice.

Rationale for Insulin Therapy Education

  • Insulin dosages may need adjustments based on activity levels; monitoring for potentially high acetone levels in urine could signal the need for more insulin.

  • Administering insulin at room temperature can minimize injection discomfort.

  • Rotating injection sites (about 1 inch apart within a designated area) helps prevent erratic absorption of insulin.

Mixing Insulin

  • When mixing regular insulin and NPH, the correct sequence is:

    • Inject air into NPH insulin after injecting air into regular insulin.

    • Withdraw regular insulin first to prevent contamination of the regular insulin vial.

Glimepiride (Amaryl) Guidance

  • Patients prescribed Glimepiride are warned against:

    • Alcohol Consumption: Alcohol can cause a disulfiram-like reaction and increase hypoglycemic effects.

    • Other medications do not require avoidance unless advised.

Exenatide (Byetta) Administration Precautions

  • Exenatide is contraindicated for clients with type 1 diabetes on insulin therapy.

    • The nurse must hold the dosage and clarify with the healthcare provider.

Humulin NPH Insulin Administration

  • For patients on Humulin NPH insulin, hypoglycemic reactions are most likely to occur:

    • 60-90 minutes after administration, due to its peak action time of 4-12 hours postdosing.

Medication Interactions and Side Effects

  • Prednisone may exacerbate hyperglycemia in patients taking glyburide, a medication for diabetes.

  • Loperamide (Imodium) is used for diarrhea management, not constipation or other GI issues.

  • Ondansetron (Zofran) is indicated for nausea and vomiting, typically postoperatively.

  • Cimetidine (Tagamet) can cause confusion in the elderly due to CNS side effects; monitoring is essential.

  • Lactulose functions as a saline laxative and lowers ammonia levels.

Sucralfate Scheduling

  • Sucralfate must be administered:

    • One hour before meals and at bedtime to avoid irritation from gastric acid.

Omeprazole Effectiveness

  • Omeprazole's therapeutic effect includes alleviating heartburn associated with gastric irritation.

Triple Therapy for Helicobacter Pylori

  • Clarithromycin, esomeprazole, and amoxicillin decrease acid production and treat H. pylori infections.

Postoperative Care with Naloxone

  • After naloxone administration, monitor for increased pain levels as it may reverse analgesia.

Isoniazid (INH) Side Effects

  • Common side effects include peripheral neuritis, indicated by numbness in the extremities. Pyridoxine can help mitigate this side effect.

    • Patients should report jaundice immediately as INH can induce hepatotoxicity.

Rifampin Instructions

  • Be aware that rifampin causes orange-red discoloration of urine and should not be discontinued without provider instructions.

Warfarin (Coumadin) Management

  • Patients must avoid aspirin due to increased bleeding risk and keep vitamin K intake consistent.

Digoxin Monitoring

  • The therapeutic range for digoxin is 0.5-2 ng/mL, and hypokalemia increases toxicity risk.

Heparin Monitoring

  • The aPTT is essential for assessing the therapeutic effect of heparin sodium therapy.

Propranolol Complications

  • Monitor for wheezing or bronchospasm in clients taking propranolol, particularly those with respiratory issues.

Acute Myocardial Infarction Nursing Interventions

  • Monitor for signs of bleeding when administering thrombolytics like alteplase.

Hydrochlorothiazide Administration Concerns

  • Consider risks such as hypokalemia, hyperglycemia, and sulfa allergies in clients receiving hydrochlorothiazide.

Nitroglycerin Administration

  • If chest pain persists after nitroglycerin, assess vital signs, pain levels, and notify the RN before re-administering.

Phenazopyridine Patient Education

  • Instruct clients about the reddish discoloration of urine and clarify that it does not cure infections.

Monitoring for Adverse Reactions to Parkinson's Medications

  • Be attentive to any impaired voluntary movements which may indicate adverse effects of carbidopa-levodopa.

Phenytoin Education

  • Clients should utilize soft toothbrushes due to risks of gum tissue enlargement and have regular blood level checks for therapeutic monitoring.

DMARDs Monitoring

  • Acceptable responses to DMARD therapy include stable lab values, controlled symptoms, and improved joint motion.

Amikacin Monitoring

  • Immediate reporting of hearing loss is vital due to the risk of ototoxicity from aminoglycosides.

Pyridostigmine Management

  • Prepare to administer atropine sulfate in the event of a cholinergic crisis.